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Title: Does the addition of a radial artery graft improve survival after higher risk coronary artery bypass grafting? A propensity-score analysis of a multicentre database.
Austin Authors: Hayward, Philip A R;Yap, Cheng Hon;Shi, William Y;Buxton, Brian F ;Dinh, Diem T;Reid, Christopher M;Shardey, Gilbert C;Smith, Julian A
Affiliation: Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
Issue Date: 18-Mar-2013
Publication information: European Journal of Cardio-thoracic Surgery : Official Journal of the European Association For Cardio-thoracic Surgery 2013; 44(3): 497-504; discussion 504-5
Abstract: The use of the radial artery as a second arterial graft during coronary surgery has grown in popularity due to high patency and low harvest site complication rates. We sought to assess whether higher risk patients derive prognostic benefit.From 2001 to 2009, 11,388 patients underwent isolated primary multivessel coronary surgery. We identified a higher risk subgroup (n = 2581) according to emergent status, coronary instability, low ejection fraction and/or aortic counterpulsation. Among these, 1832 (71%) received at least one radial artery graft in addition to a left internal thoracic artery (LITA). The remaining 749 (29%) received LITA and veins only.Patients not receiving a radial artery were more likely to be elderly, female, have poor left ventricular function or be of emergent status. These patients experienced higher unadjusted 30-day mortality (radial: 2% vs vein: 8%, P < 0.0001) with lower unadjusted 7-year survival (80 ± 1.3 vs 67 ± 2.4%, P < 0.0001). Subsequently, 515 patients in the radial group were propensity-matched to 515 receiving LITA + veins (mean logistic EuroSCORE, radial: 11.6 ± 9.7% vs vein: 11.6 ± 10.3%, P = 0.99). At 30 days, there were comparable rates of mortality (radial: 4% vs vein: 3%, P > 0.99), stroke (1 vs 1%, P > 0.99), myocardial infarction (1 vs 2%, P = 0.79), and any morbidity/mortality (34 vs 35%, P = 0.95). At 7 years, survival rates between the radial and vein groups were similar (radial: 75 ± 2.6% vs vein: 74 ± 2.9%, P = 0.65).Patients with the greatest coronary instability, urgency of surgery or impairment of ventricular function are not disadvantaged in early outcomes or mid-term survival by the use of only a single arterial graft.
Gov't Doc #: 23509235
DOI: 10.1093/ejcts/ezt116
Type: Journal Article
Subjects: Angina
Coronary artery bypass graft surgery
Ischaemic heart disease
Risk analysis/modelling
Coronary Artery Bypass.adverse effects.methods.mortality
Kaplan-Meier Estimate
Postoperative Complications.etiology.mortality
Propensity Score
Radial Artery.transplantation
Retrospective Studies
Appears in Collections:Journal articles

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