title: Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial.
abstract: BACKGROUND
  Arterial grafts are thought to be better conduits than saphenous vein grafts for coronary artery bypass grafting (CABG) based on experience with using the left internal mammary artery to bypass the left anterior descending coronary artery. The efficacy of the radial artery graft is less clear.
  
  
  OBJECTIVE
  To compare 1-year angiographic patency of radial artery grafts vs saphenous vein grafts in patients undergoing elective CABG.
  
  
  METHODS
  Multicenter, randomized controlled trial conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers among 757 participants (99% men) undergoing first-time elective CABG.
  
  
  METHODS
  The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs saphenous vein graft.
  
  
  METHODS
  The primary end point was angiographic graft patency at 1 year after CABG. Secondary end points included angiographic graft patency at 1 week after CABG, myocardial infarction, stroke, repeat revascularization, and death.
  
  
  RESULTS
  Analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). There was no significant difference in study graft patency at 1 year after CABG (radial artery, 238/266; 89%; 95% confidence interval [CI], 86%-93%; saphenous vein, 239/269; 89%; 95% CI, 85%-93%; adjusted OR, 0.99; 95% CI, 0.56-1.74; P = .98). There were no significant differences in the secondary end points.
  
  
  CONCLUSIONS
  Among Veterans Affairs patients undergoing first-time elective CABG, the use of a radial artery graft compared with saphenous vein graft did not result in greater 1-year patency.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00054847.
authors.affiliation: Cardiology Section (1-111C), Southern Arizona VA Health Care System, 3601 S Sixth Ave, Tucson, AZ 85723, USA. steven.goldman@va.gov
authors.forename: Steven
authors.initials: S
authors.lastname: Goldman
authors.forename: Gulshan K
authors.initials: GK
authors.lastname: Sethi
authors.forename: William
authors.initials: W
authors.lastname: Holman
authors.forename: Hoang
authors.initials: H
authors.lastname: Thai
authors.forename: Edward
authors.initials: E
authors.lastname: McFalls
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Ward
authors.forename: Rosemary F
authors.initials: RF
authors.lastname: Kelly
authors.forename: Birger
authors.initials: B
authors.lastname: Rhenman
authors.forename: Gareth H
authors.initials: GH
authors.lastname: Tobler
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
authors.forename: Ernesto
authors.initials: E
authors.lastname: Soltero
authors.forename: Mohammed
authors.initials: M
authors.lastname: Moursi
authors.forename: Miguel
authors.initials: M
authors.lastname: Haime
authors.forename: Michael
authors.initials: M
authors.lastname: Crittenden
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
authors.forename: Michelle
authors.initials: M
authors.lastname: Ratliff
authors.forename: Stewart
authors.initials: S
authors.lastname: Pett
authors.forename: Anand
authors.initials: A
authors.lastname: Irimpen
authors.forename: William
authors.initials: W
authors.lastname: Gunnar
authors.forename: Donald
authors.initials: D
authors.lastname: Thomas
authors.forename: Stephen
authors.initials: S
authors.lastname: Fremes
authors.forename: Thomas
authors.initials: T
authors.lastname: Moritz
authors.forename: Domenic
authors.initials: D
authors.lastname: Reda
authors.forename: Lynn
authors.initials: L
authors.lastname: Harrison
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.forename: Yajie
authors.initials: Y
authors.lastname: Wang
authors.forename: Lori
authors.initials: L
authors.lastname: Planting
authors.forename: Meredith
authors.initials: M
authors.lastname: Miller
authors.forename: Yvette
authors.initials: Y
authors.lastname: Rodriguez
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Juneman
authors.forename: Douglass
authors.initials: D
authors.lastname: Morrison
authors.forename: Mary Kaye
authors.initials: MK
authors.lastname: Pierce
authors.forename: Sandra
authors.initials: S
authors.lastname: Kreamer
authors.forename: Mei-Chiung
authors.initials: MC
authors.lastname: Shih
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lee
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D009204:Myocardial Revascularization; D017534:Radial Artery / Q000637:transplantation*; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D020521:Stroke; D016896:Treatment Outcome; D014654:Vascular Patency