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Title: Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery.
Austin Authors: Gaudino, Mario;Benedetto, Umberto;Fremes, Stephen;Biondi-Zoccai, Giuseppe;Sedrakyan, Art;Puskas, John D;Angelini, Gianni D;Buxton, Brian;Frati, Giacomo;Hare, David L ;Hayward, Philip A R;Nasso, Giuseppe;Moat, Neil;Peric, Miodrag;Yoo, Kyung J;Speziale, Giuseppe;Girardi, Leonard N;Taggart, David P
Affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine
Department of Healthcare Policy and Research, Weill Cornell Medicine
Icahn School of Medicine at Mount Sinai, New York
Bristol Heart Institute, Bristol, UK
Royal Brompton and Harefield Trust, London, UK
University of Oxford, Oxford, UK
Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto, Canada
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome
Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
Anthea Hospital, Bari, Italy
University of Melbourne, Melbourne, Victoria, Australia
Austin Health
Dedinje Cardiovascular Institute, Serbia
Belgrade University School of Medicine, Belgrade, Serbia
Yonsei University College of Medicine, Seoul, South Korea
Issue Date: 30-Apr-2018
Date: 2018-04-30
Publication information: The New England Journal of Medicine 2018; online first: 30 Apr
Abstract: Background The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts. However, randomized, controlled trials comparing radial-artery grafts and saphenous-vein grafts have been individually underpowered to detect differences in clinical outcomes. We performed a patient-level combined analysis of randomized, controlled trials to compare radial-artery grafts and saphenous-vein grafts for CABG. Methods Six trials were identified. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization. The secondary outcome was graft patency on follow-up angiography. Mixed-effects Cox regression models were used to estimate the treatment effect on the outcomes. Results A total of 1036 patients were included in the analysis (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts). After a mean (±SD) follow-up time of 60±30 months, the incidence of adverse cardiac events was significantly lower in association with radial-artery grafts than with saphenous-vein grafts (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01). At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P<0.001). As compared with the use of saphenous-vein grafts, the use of radial-artery grafts was associated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68). Conclusions As compared with the use of saphenous-vein grafts, the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. (Funded by Weill Cornell Medicine and others.).
DOI: 10.1056/NEJMoa1716026
Journal: The New England Journal of Medicine
PubMed URL: 29708851
Type: Journal Article
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