The radial artery versus the saphenous vein graft in contemporary CABG: A case-matched study

Background. Although use of the internal thoracic artery has been shown to improve outcomes after coronary artery bypass grafting, the same cannot be said of alternative arterial conduits. To determine the benefit of radial a rtery (RA) grafting, a case-matched review was undertaken. Methods. Between March 1994 and March 1999, 2,847 patients underwent isolat ed coronary artery bypass grafting with a left internal thoracic artery gra ft, plus saphenous vein grafts (SVGs). Of these patients, 478 also received an RA graft (RA group). The RA patients were matched at a ratio of 1:2 wit h patients receiving only SVGs and a left internal thoracic artery graft (S VG group; n = 956) using six prognostic risk factors: age, sex, Canadian Ca rdiovascular Society class, left ventricular grade, number of diseased vess els, and timing of operation. Target vessels were graded according to quali ty and graftability and were similar between groups. Outcomes were evaluate d by univariate and multivariate analyses. Results. There was a significantly higher prevalence of diabetes, hypertens ion, and peripheral vascular disease in the RA group (p < 0.05). Although s tay in the intensive care unit was shorter in the RA group (RA, 30 +/- 2 ho urs, and SVG, 37 +/- 2 hours; p = 0.0002), total hospital stay was similar between groups. The incidence of perioperative myocardial infarction was hi gher in the SVG group (SVG, 31 of 956 or 3.2%, and RA, 6 of 478 or 1.3%; p = 0.02). Multivariate analysis revealed RA grafting to be protective agains t early mortality and morbidity (odds ratio = 0.58; 95% confidence interval , 0.37 to 0.90; p = 0.015) and late mortality and morbidity including late reintervention (risk ratio = 0.60; 95% confidence interval, 0.37 to 0.93; p = 0.02). Actuarial freedom from events at 36 months postoperatively was gr eater in the RA group (RA, 95% +/- 2%, and SVG, 86% +/- 4%; p = 0.01). Conclusions. Despite a higher prevalence of preoperative comorbidity, patie nts in the RA group demonstrated improved outcomes after coronary artery by pass grafting. The RA is a viable and beneficial conduit for this operation . (Ann Thorac Surg 2001;71:180-6) (C) 2001 by The Society of Thoracic Surge ons.