Comparison of Radial Artery and Saphenous Vein Graft Stenosis More Than 5 Years After Coronary Artery Bypass Grafting

• Published in: The Annals of thoracic surgery Vol. 102; no. 3; pp. 712 - 719
• Main Authors: Yamasaki, Manabu, MD, Deb, Saswata, MD, Tsubota, Hideki, MD, PhD, Moussa, Fuad, MD, Kiss, Alex, PhD, Cohen, Eric A., MD, Radhakrishnan, Sam, MD, Dubbin, James, MD, Ko, Dennis, MD, PhD, Schwartz, Leonard, MD, Fremes, Stephen E., MD, MSc
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.09.2016
• Subjects: Aged; Cardiothoracic Surgery; Coronary Angiography; Coronary Artery Bypass - adverse effects; Female; Graft Occlusion, Vascular - etiology; Humans; Male; Middle Aged; Radial Artery - diagnostic imaging; Radial Artery - transplantation; Saphenous Vein - diagnostic imaging; Saphenous Vein - transplantation; Surgery; Time Factors; major adverse cardiac events; saphenous vein graft; thrombolysis in myocardial infarction; SVG; myocardial infarction; ECG; LVEF; left ventricular ejection fraction; RA; CTA; electrocardiogram; percutaneous coronary intervention; RAPS; computed tomographic angiography; MACE; TIMI; ITA; PCI; Radial Artery Patency Study; internal thoracic artery; CABG; MI; radial artery; coronary artery bypass grafting
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.02.107

Background Graft stenosis may be associated with future graft failure. The purpose of this investigation was to compare graft stenosis between radial artery (RA) grafts and saphenous vein grafts (SVGs) at least 5 years postoperatively using the multicenter Radial Artery Patency Study (RAPS) data. Methods Two hundred thirty-four patients underwent late invasive angiography after coronary artery bypass operations. The study population consists of 163 patients with thrombolysis in myocardial infarction (TIMI) 3 flow of both the RA graft and study SVGs. Angiograms were reviewed centrally and in a blinded fashion. Graft stenosis was recorded for the proximal anastomosis, graft body, and distal anastomosis; significant stenosis was defined as greater than or equal to 50%. Major adverse cardiac events (MACE) were reported in patients with and those without significant graft stenosis. Results There was no difference in significant graft stenosis of the patent RA grafts and SVGs (14 of 163 [8.6%] versus 19 of 163 [11.7%]) or in the proximal anastomosis (5 of 163 [3.1%] versus 5 of 163 [3.1%]), graft body (6 of 163 [3.7%] versus 13 of 163 [8.0%]), or distal anastomosis (4 of 163 [2.5%] versus 5 of 163 [3.1%]) considered separately. However, the overall burden of graft body disease was higher in SVGs ( p  = 0.03). MACE was higher in patients with significant graft stenosis than in patients without stenosis (10 of 28 [35.7%] versus 7 of 135 [5.2%]; p  < 0.0001). Conclusions There was no significant difference in the rates of significant stenosis of patent RA grafts and SVGs more than 5 years postoperatively. However, the burden of graft body stenosis was less in RA grafts compared with SVGs, suggesting that the RA grafts will continue to outperform the SVGs late after operation.