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Effect of radial artery or saphenous vein conduit for the second graft on 6-year clinical outcome after coronary artery bypass grafting. Results of a randomised trial

^a The Essex Cardiothoracic Centre, Nethermayne, Essex, United Kingdom
^b Austin Hospital and University of Melbourne, Melbourne, Australia
^c Statistical Consulting Centre, University of Melbourne, Melbourne, Australia

Received 3 September 2007; received in revised form 6 March 2008; accepted 19 March 2008.

^_* Corresponding author. Address: Victorian Heart Centre, Epworth Hospital, Bridge Road, Richmond, Victoria, Australia. Tel.: +61 3 9429 4055; fax: +61 3 9428 7118. (Email: brianbuxton{at}ozemail.com.au).

Objectives: In order to determine the best conduit for coronary targets other than the left anterior descending (LAD) artery, long-term clinical outcomes following revascularisation with a radial artery or saphenous vein graft were evaluated as part of the radial artery patency and clinical outcomes (RAPCO) study. Methods: As part of the RAPCO protocol for this prospective, randomised, single-centre trial, patients aged over 70 years undergoing primary CABG were randomly assigned to use of a radial artery (n = 113) or saphenous vein (n = 112) to revascularise the best non-LAD coronary vessel. Follow-up was annual. Primary clinical end-points were death, myocardial infarction or need for revascularisation. Data were analysed by intention to treat. Results: The preoperative demographics (age, gender, presence of hypertension or diabetes mellitus) and urgency of surgery did not differ significantly between the two groups. The allocated arterial or venous conduit was utilised as intended in 104/113 and 110/112 patients, respectively. Mean number of grafts was 3.2 ± 0.9 and 3.3 ± 0.7 in the two groups. During follow-up of mean duration 6.2 years (maximum 10.8 years) there were 16 deaths in each group and 9 vs 13 other events in the radial artery and saphenous vein groups, respectively. These clinical outcomes did not differ significantly (log rank p = 0.98 for survival and p = 0.52 for event-free survival). Conclusions: Use of a radial artery or saphenous vein for the second graft during primary CABG does not significantly influence clinical outcome at 6 years. Mean 5-year angiographic patency data are awaited, but from the patient's perspective the likelihood of a satisfactory long-term result is equivalent, whichever conduit is used.

Key Words: Coronary artery disease • CABG • Radial artery • Mortality