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(Circulation. 2004;109:1489-1496.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Improved Survival With Radial Artery Versus Vein Conduits in Coronary Bypass Surgery With Left Internal Thoracic Artery to Left Anterior Descending Artery Grafting

Anoar Zacharias, MD; Robert H. Habib, PhD; Thomas A. Schwann, MD; Christopher J. Riordan, MD; Samuel J. Durham, MD; Aamir Shah, MD

From the Division of Cardiovascular Surgery, St Vincent Mercy Medical Center, Toledo (A.Z., R.H.H., T.A.S., C.J.R., S.J.D., A.S.); Division of Cardiovascular Surgery, St Luke’s Hospital, Maumee (A.Z., R.H.H., T.A.S., C.J.R., S.J.D., A.S.); and Departments of Surgery (A.Z., T.A.S., C.J.R., S.J.D., A.S.) and Medicine (R.H.H.), Medical College of Ohio, Toledo, Ohio.

Correspondence to Dr Robert H. Habib, Director, Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry St, ACC Bldg, Suite 309, Toledo, OH 43608. E-mail Robert_Habib{at}mhsnr.org

Received October 21, 2003; revision received January 9, 2004; accepted January 9, 2004.

Background— Given its proven survival benefit, left internal thoracic artery to left anterior descending (LITA-LAD) grafting has become a fundamental part of CABG. This grafting also led to increased use of other arterial conduits, of which the radial artery is most popular. Whether radial grafting improves survival beyond that achieved by LITA-LAD alone is not known.

Methods and Results— We compared 6-year outcomes in propensity-matched CABG-LITA-LAD patients (925 each) divided into those with 1 radial grafts and those with vein-only grafting. Matched patients had essentially identical demographics, comorbidities, coronary disease, and operative data. Perioperative outcomes, including death (radial, 11 [1.2%]; vein, 10 [1.1%]), were similar for the 2 groups. Cumulative 0- to 6-year survival was better for radial patients (risk ratio, 0.675), particularly after 3 years (P<0.03). Six-year survival in vein (86.8%) and radial (92.1%) patients indicated 67% greater overall vein mortality. Incidence rates of radial and vein repeated catheterization (190 of 925 [20.5%] versus 199 of 925 [21.5%]) and revascularization (8.8% versus 8.5%) were similar. Angiography data in restudied symptomatic patients showed a trend for greater radial patency. Vein failure (66 of 161 [41%]) was significantly worse than radial failure (46 of 157 [29.3%]) in patients receiving both types of grafts (P=0.039).

Conclusions— Using radial as a second arterial conduit in CABG-LITA-LAD as opposed to vein grafting improves long-term outcomes as a result of decreased late deaths, especially after the third postoperative year.

Key Words: angiography • revascularization • coronary disease • restenosis

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