title: Does the addition of a radial artery graft improve survival after higher risk coronary artery bypass grafting? A propensity-score analysis of a multicentre database.
abstract: OBJECTIVE
  The use of the radial artery as a second arterial graft during coronary surgery has grown in popularity due to high patency and low harvest site complication rates. We sought to assess whether higher risk patients derive prognostic benefit.
  
  
  METHODS
  From 2001 to 2009, 11,388 patients underwent isolated primary multivessel coronary surgery. We identified a higher risk subgroup (n = 2581) according to emergent status, coronary instability, low ejection fraction and/or aortic counterpulsation. Among these, 1832 (71%) received at least one radial artery graft in addition to a left internal thoracic artery (LITA). The remaining 749 (29%) received LITA and veins only.
  
  
  RESULTS
  Patients not receiving a radial artery were more likely to be elderly, female, have poor left ventricular function or be of emergent status. These patients experienced higher unadjusted 30-day mortality (radial: 2% vs vein: 8%, P < 0.0001) with lower unadjusted 7-year survival (80 ± 1.3 vs 67 ± 2.4%, P < 0.0001). Subsequently, 515 patients in the radial group were propensity-matched to 515 receiving LITA + veins (mean logistic EuroSCORE, radial: 11.6 ± 9.7% vs vein: 11.6 ± 10.3%, P = 0.99). At 30 days, there were comparable rates of mortality (radial: 4% vs vein: 3%, P > 0.99), stroke (1 vs 1%, P > 0.99), myocardial infarction (1 vs 2%, P = 0.79), and any morbidity/mortality (34 vs 35%, P = 0.95). At 7 years, survival rates between the radial and vein groups were similar (radial: 75 ± 2.6% vs vein: 74 ± 2.9%, P = 0.65).
  
  
  CONCLUSIONS
  Patients with the greatest coronary instability, urgency of surgery or impairment of ventricular function are not disadvantaged in early outcomes or mid-term survival by the use of only a single arterial graft.
authors.affiliation: Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia. philip.hayward@austin.org.au
authors.forename: Philip A
authors.initials: PA
authors.lastname: Hayward
authors.forename: Cheng Hon
authors.initials: CH
authors.lastname: Yap
authors.forename: William Y
authors.initials: WY
authors.lastname: Shi
authors.forename: Brian F
authors.initials: BF
authors.lastname: Buxton
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Gilbert C
authors.initials: GC
authors.lastname: Shardey
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies
keywords: Angina; CABG; Cardiac; Coronary artery bypass graft surgery; Ischaemic heart disease; Risk analysis/modelling; Statistics