Gaudino M, et al. - A patient-level combined analysis of randomized, controlled trials was performed to compare radial-artery grafts and saphenous-vein grafts for coronary-artery bypass grafting (CABG). The use of radial-artery grafts, compared with the use of saphenous-vein grafts, for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up.

Methods

• Researchers identified 6 trials.
• A composite of death, myocardial infarction, or repeat revascularization were included in the primary outcome.
• Graft patency on follow-up angiography was assessed as the secondary outcome.
• To estimate the treatment effect on the outcomes, they used mixed-effects Cox regression models.

Results

• The analysis included 1,036 patients (534 patients with radial-artery grafts and 502 patients with saphenous-vein grafts).
• The incidence of adverse cardiac events was noted to be significantly lower in association with radial-artery grafts than with saphenous-vein grafts after a mean (±SD) follow-up time of 60±30 months (hazard ratio, 0.67; 95% confidence interval [CI], 0.49 to 0.90; P=0.01).
• At follow-up angiography (mean follow-up, 50±30 months), the use of radial-artery grafts was also associated with a significantly lower risk of occlusion (hazard ratio, 0.44; 95% CI, 0.28 to 0.70; P < 0.001).
• The use of radial-artery grafts, compared with the use of saphenous-vein grafts, was correlated with a nominally lower incidence of myocardial infarction (hazard ratio, 0.72; 95% CI, 0.53 to 0.99; P=0.04) and a lower incidence of repeat revascularization (hazard ratio, 0.50; 95% CI, 0.40 to 0.63; P<0.001) but not a lower incidence of death from any cause (hazard ratio, 0.90; 95% CI, 0.59 to 1.41; P=0.68).