Outcomes following revascularization with radial artery bypass grafts: Insights from the PREVENT-IV trial - 17/09/20
, Morgan L. Cox, MD, MHS a, b, David Ranney, MD a, Judson B. Williams, MD, MHS a, c, Hillary Mulder, MS b, Mario F.L. Gaudino, MD d, Stephen Fremes, MD e, Robert H. Habib, PhD f, C. Michael Gibson, MD, MS g, Thomas A. Schwann, MD h, Renato D. Lopes, MD, PhD b, John H. Alexander, MD, MHS bAbstract |
Background |
The optimal role of radial artery grafts in coronary artery bypass grafting (CABG) remains uncertain. The purpose of this study was to examine angiographic and clinical outcomes following CABG among patients who received a radial artery graft.
Methods |
Patients in the angiographic cohort of the PREVENT-IV trial were stratified based upon having received a radial artery graft or not during CABG. Baseline characteristics and 1-year angiographic and 5-year clinical outcomes were compared between patients.
Results |
Of 1,923 patients in the angiographic cohort of PREVENT-IV, 117 received a radial artery graft. These patients had longer surgical procedures (median 253 vs 228 minutes, P < .001) and had a greater number of grafts placed (P < .0001). Radial artery grafts had a graft-level failure rate of 23.0%, which was similar to vein grafts (25.2%) and higher than left internal mammary artery grafts (8.3%). The hazard of the composite clinical outcome of death, myocardial infarction, or repeat revascularization was similar for both cohorts (adjusted hazard ratio 0.896, 95% CI 0.609-1.319, P = .58). Radial graft failure rates were higher when used to bypass moderately stenotic lesions (<75% stenosis, 37% failure) compared with severely stenotic lesions (≥75% stenosis, 15% failure).
Conclusions |
Radial artery grafts had early failure rates comparable to saphenous vein and higher than left internal mammary artery grafts. Use of a radial graft was not associated with a different rate of death, myocardial infarction, or postoperative revascularization. Despite the significant potential for residual confounding associated with post hoc observational analyses of clinical trial data, these findings suggest that when clinical circumstances permit, the radial artery is an acceptable alternative to saphenous vein and should be used to bypass severely stenotic target vessels.
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| All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. |
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| Funding: Funding for this study was provided by National Institutes of Health grant 5T32HL069749 and the Duke Clinical Research Institute. |
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| Disclosures: none. |
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| Meeting presentation: This paper was presented at the American Association for Thoracic Surgery Annual Meeting in April 2019. |
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| Hartzell V. Schaff, MD, served as guest editor for this article. |
Vol 228
P. 91-97 - octobre 2020 Retour au numéro
Article précédent
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