Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: A randomized trial

Steven Goldman; Gulshan K. Sethi; William Holman; Hoang Thai; Edward McFalls; Herbert B. Ward; Rosemary F. Kelly; Birger Rhenman; Gareth H. Tobler; Faisal G. Bakaeen; Joseph Huh; Ernesto Soltero; Mohammed Moursi; Miguel Haime; Michael Crittenden; Vigneshwar Kasirajan; Michelle Ratliff; Stewart Pett; Anand Irimpen; William Gunnar; Donald Thomas; Stephen Fremes; Thomas Moritz; Domenic Reda; Lynn Harrison; Todd H. Wagner; Yajie Wang; Lori Planting; Meredith Miller; Yvette Rodriguez; Elizabeth Juneman; Douglass Morrison; Mary Kaye Pierce; Sandra Kreamer; Mei Chiung Shih; Kelvin Lee

doi:10.1001/jama.2010.1976

Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: A randomized trial

Steven Goldman, Gulshan K. Sethi, William Holman, Hoang Thai, Edward McFalls, Herbert B. Ward, Rosemary F. Kelly, Birger Rhenman, Gareth H. Tobler, Faisal G. Bakaeen, Joseph Huh, Ernesto Soltero, Mohammed Moursi, Miguel Haime, Michael Crittenden, Vigneshwar Kasirajan, Michelle Ratliff, Stewart Pett, Anand Irimpen, William GunnarDonald Thomas, Stephen Fremes, Thomas Moritz, Domenic Reda, Lynn Harrison, Todd H. Wagner, Yajie Wang, Lori Planting, Meredith Miller, Yvette Rodriguez, Elizabeth Juneman, Douglass Morrison, Mary Kaye Pierce, Sandra Kreamer, Mei Chiung Shih, Kelvin Lee

Surgery

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Abstract

Context: Arterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with using the left internal mammary artery to bypass the left anterior descending coronary artery. The efficacy of the radial artery graft is less clear. Objective: To compare 1-year angiographic patency of radial artery grafts vs saphenous vein grafts in patients undergoing elective CABG. Design, Setting, and Participants: Multicenter, randomized controlled trial conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers among 757 participants (99% men) undergoing first-time elective CABG. Interventions: The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs saphenous vein graft. Main Outcome Measures: The primary end point was angiographic graft patency at 1 year after CABG. Secondary end points included angiographic graft patency at 1 week after CABG, myocardial infarction, stroke, repeat revascularization, and death. Results: Analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). There was no significant difference in study graft patency at 1 year after CABG (radial artery, 238/266; 89%; 95% confidence interval [CI], 86%-93%; saphenous vein, 239/269; 89%; 95% CI, 85%-93%; adjusted OR, 0.99; 95% CI, 0.56-1.74; P=.98). There were no significant differences in the secondary end points. Conclusion: Among Veterans Affairs patients undergoing first-time elective CABG, the use of a radial artery graft compared with saphenous vein graft did not result in greater 1-year patency. Trial Registration: clinicaltrials.gov Identifier: NCT00054847

Original language	English (US)
Pages (from-to)	167-174
Number of pages	8
Journal	JAMA
Volume	305
Issue number	2
DOIs	https://doi.org/10.1001/jama.2010.1976
State	Published - Jan 12 2011

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Goldman, S., Sethi, G. K., Holman, W., Thai, H., McFalls, E., Ward, H. B., Kelly, R. F., Rhenman, B., Tobler, G. H., Bakaeen, F. G., Huh, J., Soltero, E., Moursi, M., Haime, M., Crittenden, M., Kasirajan, V., Ratliff, M., Pett, S., Irimpen, A., ... Lee, K. (2011). Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: A randomized trial. JAMA, 305(2), 167-174. https://doi.org/10.1001/jama.2010.1976

Goldman, S, Sethi, GK, Holman, W, Thai, H, McFalls, E, Ward, HB, Kelly, RF, Rhenman, B, Tobler, GH, Bakaeen, FG, Huh, J, Soltero, E, Moursi, M, Haime, M, Crittenden, M, Kasirajan, V, Ratliff, M, Pett, S, Irimpen, A, Gunnar, W, Thomas, D, Fremes, S, Moritz, T, Reda, D, Harrison, L, Wagner, TH, Wang, Y, Planting, L, Miller, M, Rodriguez, Y, Juneman, E, Morrison, D, Pierce, MK, Kreamer, S, Shih, MC & Lee, K 2011, 'Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: A randomized trial', JAMA, vol. 305, no. 2, pp. 167-174. https://doi.org/10.1001/jama.2010.1976

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title = "Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: A randomized trial",

abstract = "Context: Arterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with using the left internal mammary artery to bypass the left anterior descending coronary artery. The efficacy of the radial artery graft is less clear. Objective: To compare 1-year angiographic patency of radial artery grafts vs saphenous vein grafts in patients undergoing elective CABG. Design, Setting, and Participants: Multicenter, randomized controlled trial conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers among 757 participants (99% men) undergoing first-time elective CABG. Interventions: The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs saphenous vein graft. Main Outcome Measures: The primary end point was angiographic graft patency at 1 year after CABG. Secondary end points included angiographic graft patency at 1 week after CABG, myocardial infarction, stroke, repeat revascularization, and death. Results: Analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). There was no significant difference in study graft patency at 1 year after CABG (radial artery, 238/266; 89%; 95% confidence interval [CI], 86%-93%; saphenous vein, 239/269; 89%; 95% CI, 85%-93%; adjusted OR, 0.99; 95% CI, 0.56-1.74; P=.98). There were no significant differences in the secondary end points. Conclusion: Among Veterans Affairs patients undergoing first-time elective CABG, the use of a radial artery graft compared with saphenous vein graft did not result in greater 1-year patency. Trial Registration: clinicaltrials.gov Identifier: NCT00054847",

author = "Steven Goldman and Sethi, {Gulshan K.} and William Holman and Hoang Thai and Edward McFalls and Ward, {Herbert B.} and Kelly, {Rosemary F.} and Birger Rhenman and Tobler, {Gareth H.} and Bakaeen, {Faisal G.} and Joseph Huh and Ernesto Soltero and Mohammed Moursi and Miguel Haime and Michael Crittenden and Vigneshwar Kasirajan and Michelle Ratliff and Stewart Pett and Anand Irimpen and William Gunnar and Donald Thomas and Stephen Fremes and Thomas Moritz and Domenic Reda and Lynn Harrison and Wagner, {Todd H.} and Yajie Wang and Lori Planting and Meredith Miller and Yvette Rodriguez and Elizabeth Juneman and Douglass Morrison and Pierce, {Mary Kaye} and Sandra Kreamer and Shih, {Mei Chiung} and Kelvin Lee",

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T2 - A randomized trial

AU - Goldman, Steven

AU - Sethi, Gulshan K.

AU - Holman, William

AU - Thai, Hoang

AU - McFalls, Edward

AU - Ward, Herbert B.

AU - Kelly, Rosemary F.

AU - Rhenman, Birger

AU - Tobler, Gareth H.

AU - Bakaeen, Faisal G.

AU - Huh, Joseph

AU - Soltero, Ernesto

AU - Moursi, Mohammed

AU - Haime, Miguel

AU - Crittenden, Michael

AU - Kasirajan, Vigneshwar

AU - Ratliff, Michelle

AU - Pett, Stewart

AU - Irimpen, Anand

AU - Gunnar, William

AU - Thomas, Donald

AU - Fremes, Stephen

AU - Moritz, Thomas

AU - Reda, Domenic

AU - Harrison, Lynn

AU - Wagner, Todd H.

AU - Wang, Yajie

AU - Planting, Lori

AU - Miller, Meredith

AU - Rodriguez, Yvette

AU - Juneman, Elizabeth

AU - Morrison, Douglass

AU - Pierce, Mary Kaye

AU - Kreamer, Sandra

AU - Shih, Mei Chiung

AU - Lee, Kelvin

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N2 - Context: Arterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with using the left internal mammary artery to bypass the left anterior descending coronary artery. The efficacy of the radial artery graft is less clear. Objective: To compare 1-year angiographic patency of radial artery grafts vs saphenous vein grafts in patients undergoing elective CABG. Design, Setting, and Participants: Multicenter, randomized controlled trial conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers among 757 participants (99% men) undergoing first-time elective CABG. Interventions: The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs saphenous vein graft. Main Outcome Measures: The primary end point was angiographic graft patency at 1 year after CABG. Secondary end points included angiographic graft patency at 1 week after CABG, myocardial infarction, stroke, repeat revascularization, and death. Results: Analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). There was no significant difference in study graft patency at 1 year after CABG (radial artery, 238/266; 89%; 95% confidence interval [CI], 86%-93%; saphenous vein, 239/269; 89%; 95% CI, 85%-93%; adjusted OR, 0.99; 95% CI, 0.56-1.74; P=.98). There were no significant differences in the secondary end points. Conclusion: Among Veterans Affairs patients undergoing first-time elective CABG, the use of a radial artery graft compared with saphenous vein graft did not result in greater 1-year patency. Trial Registration: clinicaltrials.gov Identifier: NCT00054847

AB - Context: Arterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with using the left internal mammary artery to bypass the left anterior descending coronary artery. The efficacy of the radial artery graft is less clear. Objective: To compare 1-year angiographic patency of radial artery grafts vs saphenous vein grafts in patients undergoing elective CABG. Design, Setting, and Participants: Multicenter, randomized controlled trial conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers among 757 participants (99% men) undergoing first-time elective CABG. Interventions: The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs saphenous vein graft. Main Outcome Measures: The primary end point was angiographic graft patency at 1 year after CABG. Secondary end points included angiographic graft patency at 1 week after CABG, myocardial infarction, stroke, repeat revascularization, and death. Results: Analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). There was no significant difference in study graft patency at 1 year after CABG (radial artery, 238/266; 89%; 95% confidence interval [CI], 86%-93%; saphenous vein, 239/269; 89%; 95% CI, 85%-93%; adjusted OR, 0.99; 95% CI, 0.56-1.74; P=.98). There were no significant differences in the secondary end points. Conclusion: Among Veterans Affairs patients undergoing first-time elective CABG, the use of a radial artery graft compared with saphenous vein graft did not result in greater 1-year patency. Trial Registration: clinicaltrials.gov Identifier: NCT00054847

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Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: A randomized trial

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