title: Searching for the second best graft for coronary artery bypass surgery: a network meta-analysis of randomized controlled trials†.
abstract: OBJECTIVE
  There is a lack of unequivocal evidence basis for selecting the best second conduit in coronary artery bypass grafting (CABG). We thus aimed to perform head-to-head relative effect estimate on angiographic outcomes for second conduits, including the right internal mammary artery (RIMA), radial artery (RA), right gastroepiploic artery (RGEA) and saphenous vein graft (SVG) by means of network meta-analysis of randomized controlled trials (RCTs).
  
  
  METHODS
  Databases were searched for RCTs comparing angiographic outcomes (≥4 weeks) of second conduits in CABG. Odds ratios (95% confidence intervals) were computed with Markov Chain Monte Carlo simulation.
  
  
  RESULTS
  A total of nine RCTs were identified, including 2780 patients and 1620 angiographic results available for analysis to compare RIMA (n=145) versus RA (n=871) versus RGEA (n=92) versus SVG (n=845). The mean time to angiographic follow-up ranged from 1 to 7.7 years. An SVG was significantly associated with a 4-fold (1.67-16.00) and 3-fold (0.78-22.20) increased risk of late (≥4 years) functional graft occlusion when compared with the RIMA and RA, respectively. A RIMA was associated with a non-significant 27% absolute risk reduction for functional graft occlusion when compared with the RA.
  
  
  CONCLUSIONS
  The present network meta-analysis consistently demonstrated an angiographic superiority of RIMA and RA over SVG. The RIMA is expected to achieve a better patency rate than the RA, but further studies are needed.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK umberto.benedetto@hotmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK.
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK.
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Amrani
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy Department of AngioCardio Neurology, IRCCS NeuroMed, Pozzilli, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D024405:Gastroepiploic Artery / Q000637:transplantation; D006801:Humans; D008323:Mammary Arteries / Q000637:transplantation; D008390:Markov Chains; D009010:Monte Carlo Method; D017534:Radial Artery / Q000637:transplantation; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Coronary disease; Meta-analysis