Circulation. 2004;109:2086-2091
doi: 10.1161/01.CIR.0000127570.20508.5C
doi: 10.1161/01.CIR.0000127570.20508.5C
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(Circulation. 2004;109:2086-2091.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts
From the Departments of Cardiovascular Medicine (U.N.K., S.G.E.), Internal Medicine (D.T.F.), Cardiothoracic Surgery (G.P., N.G.S.), and Biostatistics (J.L.), The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Umesh N. Khot, MD, Indiana Heart Physicians, 112 N 17th Ave, Suite 300, Beech Grove, IN 46107. E-mail khot{at}cvresearch.net
Received November 24, 2003; accepted February 2, 2004.
Background— The radial artery has been increasingly used in CABG. However, angiographic outcome data have been limited.
Methods and Results— We reviewed all coronary angiography procedures from February 1996 to October 2001 and selected patients with a radial artery bypass graft. Angiographic outcomes were divided into groups as (1) occluded, (2) severe disease (
70% stenosis, or string sign), or (3) patent (<70% stenosis). Multivariable analyses determined predictors of severe disease or occlusion. A total of 310 patients had a radial artery graft. Mean follow-up after coronary artery bypass grafting was 565±511 days. Radial artery grafts had a patency rate of 51.3%, which was significantly lower than that for left internal mammary arteries (90.3%, P<0.0001) or saphenous vein grafts (64.0%, P=0.0016). Radial artery grafts had an occlusion rate of 33.7%, compared with 4.8% for left internal mammary arteries (P<0.0001), and had a severe stenosis rate of 15.1%, compared with 5.9% for saphenous vein grafts (P=0.0003) and 4.8% for left internal mammary arteries (P<0.0001). Women had a worse overall radial artery patency rate than men (38.9% versus 56.1%, P=0.025). A radial artery graft was the most powerful multivariable predictor of severe stenosis or occlusion (
2=28.87, P<0.0001). Because of diseased radial artery grafts, 58 patients required subsequent percutaneous intervention, and 26 patients required repeat CABG.
Conclusions— In patients predominantly presenting with signs and symptoms of myocardial ischemia after CABG, radial artery grafts have lower patency rates than left internal mammary artery and saphenous vein grafts. Selective use of the radial artery is warranted, particularly in women.
Key Words: angiography • bypass • revascularization • follow-up studies • surgery
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