title: Mid-term results of the Radial Artery Patency and Clinical Outcomes randomized trial.
abstract: BACKGROUND
  The radial artery (RA), as an alternative to the saphenous vein or the right internal thoracic artery (RITA) for coronary artery bypass grafting, has gained considerable interest over the years. A randomized controlled trial was undertaken to assess the suitability of the radial artery as a conduit.
  
  
  METHODS
  The Radial Artery Patency and Clinical Outcomes (RAPCO) trial is a double-armed randomized controlled trial comparing the RA with the free RITA in a younger cohort of patients undergoing elective coronary bypass surgery, and the RA with the saphenous vein in an older group. The trial conduit was grafted to the most important coronary target after the left anterior descending artery, which received the gold standard left internal thoracic artery. Clinical outcomes and angiographic patency up to 10 years was recorded during careful follow up, with annual clinical review and a program of randomly assigned, staggered angiography. The final trial results will be available in 2014.
  
  
  RESULTS
  Mid-trial results have shown equivalent survival and event-free survival and graft patency in both arms at median follow up of approximately 6 years. The demographic and clinical data, pre- and postoperative angiographic findings of the trial database have led to a number of substudies focusing on the role of lipid exposure in patency and disease progression, the fate of moderate lesions when grafted or left alone, patterns of disease regression, and patient satisfaction with graft harvest sites.
  
  
  CONCLUSIONS
  While the final analysis of the primary trial end points is eagerly awaited, the additional insight into the natural history of grafted coronary artery disease with modern secondary prevention will be of considerable interest.
authors: Department of Cardiac Surgery, Austin Hospital, Heidelberg, Melbourne, Victoria, Australia.
authors: Philip A
authors: PA
authors: Hayward
authors: Brian F
authors: BF
authors: Buxton
keywords: Randomized controlled trial; internal thoracic artery (ITA); radial artery (RA); saphenous vein (SV)
references: Circulation. 2008 Jun 3;117(22):2859-64
references: 18506009
references: Ann Thorac Surg. 2007 Aug;84(2):493-7; discussion 497
references: 17643621
references: J Am Coll Cardiol. 2012 Jul 3;60(1):28-35
references: 22742399
references: Eur Heart J. 2010 Oct;31(20):2470-81
references: 20805116
references: Heart Lung Circ. 2012 Feb;21(2):82-7
references: 22153966
references: J Thorac Cardiovasc Surg. 2003 Jun;125(6):1363-71
references: 12830056
references: JAMA. 2011 Jan 12;305(2):167-74
references: 21224458
references: Ann Thorac Surg. 2007 Sep;84(3):795-9
references: 17720377
references: Eur J Cardiothorac Surg. 2008 Jul;34(1):113-7
references: 18455416
references: J Thorac Cardiovasc Surg. 2014 Jul;148(1):53-9
references: 24035380
references: Eur J Cardiothorac Surg. 2014 Feb;45(2):323-8
references: 23671205
references: J Thorac Cardiovasc Surg. 2013 Feb;145(2):412-9
references: 22364894
references: Circulation. 2007 Feb 13;115(6):684-91
references: 17283268
references: J Thorac Cardiovasc Surg. 2010 Jan;139(1):60-5; discussion 65-7
references: 20106358
references: J Thorac Cardiovasc Surg. 2013 Jan;145(1):140-8; discussion 148-9
references: 23084100