Radial graft bests right internal thoracic artery, saphenous vein for CABG at 15 years
Click Here to Manage Email Alerts
Key takeaways:
- Radial artery graft conferred lower 15-year all-cause mortality vs. other approaches for coronary artery bypass grafting.
- There was no significant difference in heart attack or repeat revascularization.
Radial artery graft for the second most important coronary target was associated with lower 15-year all-cause mortality vs. right internal thoracic artery or saphenous vein graft for CABG, researchers reported.
The 15-year results of the RAPCO program were published in the European Heart Journal.
Image: Adobe Stock
“The standard CABG operation uses the left internal thoracic artery to the left anterior descending artery (LITA-LAD),” Garry W. Hamilton, MD, of the department of cardiology, Austin Health, University of Melbourne, Australia, and colleagues wrote. “However, the optimal graft for the second most important coronary target remains debated.”
The RAPCO program included two separate randomized trials: radial artery compared with free right internal thoracic artery (RAPCO-RITA) or saphenous vein graft (RAPCO-SV) for CABG in patients with left ventricular ejection fraction less than 35% and at least one non-left anterior descending vessel with a proximal stenosis of at least 70% and a diameter of at least 1.5 mm.
Patients younger than 70 years or younger than 60 years with diabetes were randomly assigned to radial artery or free right internal thoracic artery graft. Patients older than 70 years or 60 years if diabetic were randomly assigned to radial artery or saphenous vein graft.
The composite primary outcome included the 15-year rate of all-cause death, MI or repeat revascularization. Secondary outcomes included individual components of the primary composite outcome.
Radial artery vs. right internal thoracic artery graft
Hamilton and colleagues reported that the 15-year rate of the composite primary outcome was lower in the radial artery graft group compared with right internal thoracic artery graft group (39.4% vs. 48.5%; HR = 0.74; 95% CI, 0.55-0.97; P = .04).
Researchers observed a lower rate of all-cause death in the radial artery graft group compared with right internal thoracic artery graft group (22.2% vs. 30.1%; log rank P = .06; HR = 0.69; 95% CI, 0.47-1.02) and no significant difference in the rate of MI or repeat revascularization.
The association between radial artery graft and lower risk for the primary outcome compared with right internal thoracic artery graft was consistent across prespecified subgroups including age, sex, diabetes status and history of MI, according to the study.
Radial artery vs. saphenous vein graft
The 15-year rate of the primary composite outcome was 60.2% in the radial artery group compared with 73.2% in the saphenous vein graft group (HR = 0.71; 95% CI, 0.52-0.98; P = .04).
Kaplan-Meier estimated 15-year mortality rate was 52.2% in the radial artery group compared with 63.4% in the saphenous vein graft group (HR = 0.74; 95% CI, 0.52-1.04; log rank P = .08), and researchers observed no difference in the rate of MI or repeat revascularization.
The association between radial artery graft and lower risk for the primary outcome compared with saphenous vein graft was consistent across prespecified subgroups including age, sex, diabetes status and history of MI.
“This is the first single randomized trial to report superior clinical results of the radial artery compared with both the right internal thoracic artery and the saphenous vein for CABG. The clinical outcome differences in CABG clinical trials are not generally seen in the early years after randomization,” the researchers wrote. “Thus, the 15-year data from the RAPCO program are pivotal in confirming the long-term clinical benefits of radial artery grafting over other CABG conduits within a single trial structure, rather than relying on the methodologically limited reports of propensity-controlled pooled data, or patient-level meta-analyses.”
Collapse
Click Here to Manage Email Alerts