Additional Benefit from Radial Artery Graft in Myocardial Revascularization Surgery

Used to different extents according to institution, surgeon, and historical time, the radial artery graft is yet to prove whether it can improve the outcomes of myocardial revascularization surgery when added to a single or bilateral internal thoracic artery graft.

The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral vs. single left internal thoracic artery graft. In the ART, a large proportion of patients (20%) received a radial artery graft instead of a saphenous vein graft; in consequence, this analysis post hoc aimed to investigate any additional benefits.

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Among the 3102 patients enrolled, 632 received a radial artery graft additional to the single or bilateral internal thoracic artery graft, and 2105 patients received a saphenous vein graft.

The primary endpoint was a composite of acute myocardial infarction, cardiovascular death, and repeat revascularization at 5 years.

The combined endpoint was significantly lower in the radial artery graft group (8.8% vs. 13.6%; p = 0.005), mainly due to a lower rate of repeat revascularization (4.4% vs. 7.6%).

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This association was present in patients who received a single or a bilateral internal thoracic artery graft, indistinctively.

Conclusion

This post hoc ART analysis showed that an additional radial artery graft was associated with less events at 5 years when used to supplement single or bilateral internal thoracic artery grafts.

Editorial

Angiographic follow-up was carried out only in symptomatic patients, which means that graft patency could not be assessed. However, all patients who required graft revascularization had a saphenous vein graft instead of a radial artery graft.

The ART interim analysis at 5 years shows that bilateral internal thoracic artery grafts are not superior to single left internal thoracic artery grafts, although any difference in that regard would be expected much later. Maybe the 10-year follow-up will have good news for complete artery revascularization.

Original title: Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes. Insights from the Arterial Revascularization Trial.

Reference: David P. Taggart et al. Circulation. 2017 Aug 1;136(5):454-463.

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