RAPS: Better graft closure reported in radial artery vs. saphenous vein grafts

Issue: May 2011

American College of Cardiology 60th Annual Scientific Sessions

NEW ORLEANS — Among patients with three-vessel disease who underwent CABG, those who received radial artery grafts compared with saphenous vein grafts had lower rates of occlusion after more than 7 years following the procedure.

“The study we’ve presented is the first multi-institutional, longitudinal, randomized comparison, so this is fairly unique data,” said Stephen E. Fremes, MD, MSc, study lead author and head of the division of cardiac and vascular surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, in a press conference. “Hopefully it will be persuasive and won’t detract from the use of radial arteries.”

In the randomized Radial Artery Patency Study (RAPS), investigators enrolled 561 patients who underwent CABG for three-vessel disease at 13 Canadian centers. Patients were treated with both a saphenous vein graft and a radial graft at two different diseased vessel sites. The primary endpoint was functional graft occlusion at least five years after surgery, while the secondary endpoint was complete graft occlusion.

During a mean of 7.6 years following procedure in 269 patients, researchers found substantially fewer radial arteries were occluded vs. saphenous vein grafts (12% vs. 18.8%; P=.05). Similarly, rates of complete occlusion were lower in radial arteries (8.9% vs. 17.8%; P=.004), as were rates of functional graft occlusion (12% vs. 18.8%; P=.05). Furthermore, graft stenosis of greater than 25% or occlusion was also lower in the radial arm (21.9% vs. 33.8%; P=.004). – by Brian Ellis

For more information:

Fremes S. LBCT II, Session 3013. Presented at: ACC 60^th Annual Scientific Sessions; April 2-5, 2011; New Orleans.

It has pretty much fallen out of favor using the radial artery and yet since vein grafts are perceived to be so inferior to internal mammary grafts you look for something else and maybe new things will come in the future. But the RAPS trial was counter to the VA trial, which showed at one year 89% patency for veins and 89% for radial artery. Here with a longer follow-up and with a little different way the trial was done, this looks a little better. So I think this is going to reinvigorate surgeons to use radial arteries more. I would expect this will have a clinical impact.

– Spencer King III, MD

Cardiology Today Editorial Board

Disclosure: Drs. Fremes and King report no relevant financial disclosures.

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