Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/23830
Title: Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis.
Austin Authors: Gaudino, Mario;Benedetto, Umberto;Fremes, Stephen;Ballman, Karla;Biondi-Zoccai, Giuseppe;Sedrakyan, Art;Nasso, Giuseppe;Raman, Jai S ;Buxton, Brian;Hayward, Philip A;Moat, Neil;Collins, Peter;Webb, Carolyn;Peric, Miodrag;Petrovic, Ivana;Yoo, Kyung J;Hameed, Irbaz;Di Franco, Antonino;Moscarelli, Marco;Speziale, Giuseppe;Puskas, John D;Girardi, Leonard N;Hare, David L ;Taggart, David P
Affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
NHLI, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
Dedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia
Yonsei University College of Medicine, Seoul, South Korea
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
Department of Cardiovascular Surgery, Mount Sinai St. Luke's, New York, New York
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
Mediterranea Cardiocentro, Naples, Italy
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
Issue Date: Jun-2020
Publication information: JAMA 2020; 324(2): 179-187
Abstract: Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials. To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019. Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). In this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.
URI: http://ahro.austin.org.au/austinjspui/handle/1/23830
DOI: 10.1001/jama.2020.8228
ORCID: 0000-0001-9554-6556
PubMed URL: 32662861
Type: Journal Article
Appears in Collections:Journal articles

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