A Comparison Of Long-term Outcome Of Radial Artery With Saphenous Vein Graft In CABG

ObjectiveThe left internal mammary artery(LIMA) has been shown to improve the outcome of coronary artery bypass grafting(CABG) and become the gold standard graft.However the benefit of the radial artery(RA) has not been determined.The aim of this retrospective study was to compare the long-term outcome of the radial artery with the saphenous vein graft in CABGMethodsBetween January 2004 and December 2005,324 patients who were underwent isolated OPCAB composed this study.There were 79 patients received the radial artery graft(the RA group),of which 59 patients had total arterial grafts(LIMA and RA),20 patients had standard procedure(LIMA to LAD,SVG to other target vessels) with RA (LIMA,SVG and RA).The other 245 patients who underwent CABG without RA (LIMA and SVG) composed the SVG group.A complete follow-up was obtained for 254 patients from 36 to 60 months after the operation(mean 41.6 months).Coronary artery CT or angiography were performed in 59 cases after the operation,including 59 LIMA,28 RA and 129 SVG.The follow-up time ranged from 3 to 52 months(mean 32.1 months).Outcomes were evaluated by univariate analysis and survival analysis.ResultsClinic outcomes:The mean age of the RA group was younger.The clinic characters showed a significant higher prevalence of female,severe angina(CCS) and smoke in the RA group.The mean number of conduits in the RA group was fewer(RA 3.28±0.88,SVG 3.62±0.70;p＝0.004).The prevalence of taking exercise post-operatively was higher in the RA group(RA 86.6%,SVG 69.0%;p＝0.006).The actuarial survival,freedom from MACE(major adverse cardiac event) and angina at 12 months or 36 months were similar.The total survival curve showed significant benefit in the RA group(P=0.01).The MACE-free survival curve also showed significant benefit in the RA group(p=0.044).The angina-free survival curve showed no significant difference.As a subgroup analysis(age 60-70),there was no significant difference of the survival rate between two groups.Image study outcomes:Results of the LIMA grafts were all excellent.The overall patency of the radial artery grafts was higher than the SVG(RA 92.9%,SVG 76.0%; P=0.047).The rate of TVR(target vessel revascularization) of the RA graft was less (RA 0%,SVG 11.6%;p=0.036).There was no difference in the patency rate at 12 months.The patency rate of the RA graft at 24 and 36 months were superior(RA 100%,SVG 81.7%at 24 months,P=0.051;RA 100%,SVG 73.3%at 36 months, P=0.043).The patency curve showed significant benefit in the RA group(p=0.032)ConclusionThe RA graft improved survival,reduced MACE and angina after CABG The RA graft had superior patency.The long-term outcome of the RA was better than SVG...