title: Right internal thoracic artery versus radial artery as the second best arterial conduit: Insights from a meta-analysis of propensity-matched data on long-term survival.
abstract: We conducted a meta-analysis of propensity score-matching (PSM) studies comparing long-term survival of patients receiving right internal thoracic artery (RITA) versus radial artery (RA) as a second arterial conduit for coronary artery bypass grafting.
  
  
  
  A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Primary endpoint was long-term mortality. Secondary endpoints were operative mortality, incidence of sternal wound infection, and repeat revascularization. Binary events were pooled using the DerSimonian and Laird method. For time-to-event outcomes, estimates of log hazard ratio (HR) and standard errors obtained were combined using the generic inverse-variance method.
  
  
  
  A total of 8 PSM studies were finally selected including 15,374 patients (RITA, 6739; RA, 8635) with 2992 matched pairs for final comparison. Mean follow-up time ranged from 45 to 168 months. When compared with RA, RITA was associated with a lower risk reduction of late death (HR, 0.75; 95% confidence interval [CI], 0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI, 0.16-0.85; P = .03). On the other hand, RITA did not increase operative mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was associated with an increased risk of sternal wound complication when pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71).
  
  
  
  The present PSM data meta-analysis suggests that the use of RITA compared with RA was associated with superior long-term survival and freedom from repeat revascularization, with similar operative mortality and incidence of sternal wound complication when the skeletonized harvesting technique was used.
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: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
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: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tranbaugh
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Franco
authors.affiliation: National University of Singapore, Singapore.
authors.forename: Colin
authors.initials: C
authors.lastname: Ng
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
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: D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008323:Mammary Arteries / Q000637:transplantation*; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D015996:Survival Rate
keywords: propensity score matching; radial artery; right internal thoracic artery