Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts.
BACKGROUND
The radial artery has been increasingly used in CABG. However, angiographic outcome data have been limited.


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 (> or =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 (chi2=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.
Khot
Umesh N
UN
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. khot@cvresearch.net
Friedman
Daniel T
DT
Pettersson
Gosta
G
Smedira
Nicholas G
NG
Li
Jianbo
J
Ellis
Stephen G
SG
D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D009820:Ohio; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D012737:Sex Factors; D016896:Treatment Outcome