title: Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival.
abstract: Whether radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival than saphenous vein (SV) remains undetermined.
  
  
  
  Study population included a selected low-risk group of 275 subjects undergoing BITA grafting with RA as third arterial conduit (BITA+RA) and 489 undergoing BITA grafting with additional SV graft (BITA+SV). RA was considered only for target stenosis of at least 75%. We finally obtained 275 propensity score-matched pairs for comparison.
  
  
  
  Operative mortalities were 1 (0.3%) and 2 (0.7%) for BITA+RA and BITA+SV, respectively (P = .56). After mean follow-up of 10.6 ± 4.8 years, BITA+RA survivals were 97.4% ± 0.9%, 90.3% ± 2.0%, and 81.7% ± 3.2% at 5, 10, and 15 years, respectively, versus 97.0% ± 1.0%, 94.1% ± 1.5%, and 82.1% ± 3.4% (log-rank P = .54; hazard ratio, 1.16; 95% confidence interval, 0.71-1.9). Strategies showed comparable survivals when RA or SV was used to graft the right (P = .79) or left (P = .55) coronary system only. Lack of survival advantage for BITA+RA was confirmed in patients 60 years and younger (P = .80) and older than 60 years (P = .53), with and without diabetes mellitus (P = .89 and P = .54, respectively), and with or without left ventricular dysfunction (P = .95 and P = .65, respectively).
  
  
  
  Long-term survival in selected low-risk patients undergoing BITA grafting was not extended by using RA as third arterial conduit in preference to SV.
authors.affiliation: Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. Electronic address: umberto.benedetto@bristol.ac.uk.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.affiliation: Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Zakkar
authors.affiliation: Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Bryan
authors.affiliation: Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate; D016896:Treatment Outcome
keywords: bilateral internal thoracic arteries; coronary artery bypass grafting; multiple arterial grafting; radial artery; survival