Radial artery patency and clinical outcomes: five-year interim results of a randomized trial.
OBJECTIVE
This study was undertaken to compare elective angiographic patency and cardiac event-free survival of the radial artery graft with that of the free right internal thoracic artery or saphenous vein during a 10-year period after primary coronary artery bypass surgery.


METHODS
This prospective, randomized, single-center trial was conducted on two groups of patients undergoing primary coronary artery bypass surgery. In a younger group (group 1, n = 285, <70 years), the radial artery was compared with the free right internal thoracic artery. In an older group (group 2, n = 153, >/=70 years), the radial artery was compared with the saphenous vein. The trial conduit was grafted to the largest available coronary artery other than the left anterior descending coronary artery. Angiography was scheduled at intervals between 0 and 10 years according to a second random assignment. Patients were followed up at yearly intervals to assess clinical outcomes. Clinical outcomes were analyzed on an intent-to-treat basis during the 10-year follow-up with time-related analyses. This interim study reports angiographic and clinical outcome results during the first 5 years.


RESULTS
Graft patency estimates were as follows: 0.95 (95% confidence interval 0.85-0.99) in 39 radial arteries versus 1.0 in 29 right internal thoracic arteries (P =.4) in group 1, and 0.86 (95% confidence interval 0.67-0.99) in 24 radial arteries versus 0.95 (95% confidence interval 0.83-0.99) in 22 saphenous veins (P =.5) in group 2. Cardiac event-free survival estimates were as follows: 0.91 (95% confidence interval 0.76-0.99) for the radial artery versus 0.82 (95% confidence interval 0.63-0.99) for the right internal thoracic artery (P =.7) in group 1, and 0.84 (95% confidence interval 0.64-0.99) for the radial artery versus 0.89 (95% confidence interval 0.72-0.99) for the saphenous vein (P =.9) in group 2.


CONCLUSIONS
The 5-year interim results do not support the hypothesis that the radial artery has superior patency to or is associated with fewer clinical events than free right internal thoracic artery or saphenous vein grafts.
Buxton
Brian F
BF
Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia. brian.buxton@austin.org.au
Raman
Jai S
JS
Ruengsakulrach
Permyos
P
Gordon
Ian
I
Rosalion
Alex
A
Bellomo
Rinaldo
R
Horrigan
Mark
M
Hare
David L
DL
D000368:Aged; D001026:Coronary Artery Bypass; D006801:Humans; D008323:Mammary Arteries / Q000502:physiology / Q000637:transplantation; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000502:physiology* / Q000637:transplantation; D011859:Radiography; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*