CABG with radial artery graft improves outcomes vs. saphenous vein graft
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The use of radial artery grafts for CABG was linked to lower risk for CV outcomes and improved survival compared with the use of saphenous vein grafts, according to 10-year follow-up data from the Radial Artery Database International Alliance presented at the American College of Cardiology Scientific Session.
“This is the first demonstration based on randomized data of a sustained benefit in an important clinical endpoint like death and myocardial infarction with the use of the [radial artery] rather than the [saphenous vein] for CABG,” Mario F.L. Gaudino, MD, FEBCTS, Stephen and Suzanne Weiss Professor of Cardiothoracic Surgery at Weill Cornell Medicine, told Healio.
Patient-level meta-analysis
Researchers analyzed data from 1,036 patients who underwent CABG with radial artery graft (n = 534; mean age, 67 years; 70% men) or saphenous vein graft (n = 502; mean age, 67 years; 70% men).
The primary outcome was a composite of MI, death and repeat revascularization. A secondary outcome was also assessed, defined as a composite of MI and death. Follow-up was conducted by telephone interview, electronic patient record database or questionnaires for a median of 10 years.
During follow-up, patients who underwent CABG with radial artery grafts had a significantly lower incidence of the primary (HR = 0.73; 95% CI, 0.61-0.88) and the secondary outcomes (HR = 0.77; 95% CI, 0.63-0.94) compared with those who underwent the surgery with saphenous vein grafts.
The use of radial artery grafts for CABG was also associated with lower rates of MI (HR = 0.74; 95% CI, 0.54-1.02), mortality (HR = 0.73; 95% CI, 0.57-0.93) and repeat revascularizations (HR = 0.62; 95% CI, 0.45-0.86).
In a subgroup analysis, the greatest significantly modified effect was observed between men and women, with women receiving the most benefit from CABG with a radial artery graft (HR = 0.51; 95% CI, 0.36-0.72) compared with men (HR = 0.84; 95% CI, 0.68-1.05).
“The signal about a better postoperative outcome, a larger benefit in women was already there in the 5-year analysis of this data set, and this was confirmed at 10 years,” Gaudino said during the discussion. “This is probably a solid signal. I’m not 100% sure about the biologic reason, but remember that the HR is a relative measure. Saphenous vein graft tends to have worse quality in women, so it is possible the use of the radial artery in women showed larger benefit simply because the quality of the saphenous vein is generally worse.”
Further research is needed to confirm these findings. Gaudino said, “Because this is a pooled analysis, not a single trial, confirmation is required in an individual large trial. The ongoing ROMA trial will provide the needed answer.”
‘Potentially practice changing’
“This really brings home the point that the radial artery is better than the saphenous vein graft in general and overall,” panelist Marc R. Moon, MD, John M. Shoenberg Professor of Surgery, chief of the section of cardiac surgery and program director of the thoracic surgery residency program at Washington University School of Medicine in St. Louis, said during the discussion.
“Fantastic study. I think the results are potentially practice-changing and believable and consistent with other sorts of observational datasets,” Cardiology Today Editorial Board Member Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, said during the panel discussion. – by Darlene Dobkowski
Reference:
Gaudino MFL, et al. Late-Breaking Clinical Trials IV. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Disclosures: Gaudino reports he is a principal investigator for the ROMA trial. Bhatt reports he has financial ties with numerous pharmaceutical and device companies. Cardiology Today could not confirm relevant financial disclosures for Moon at the time of publication.
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