Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting

Abstract

IMPORTANCE Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials.OBJECTIVE To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. DESIGN, SETTING, AND PARTICIPANTSPatient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019.INTERVENTIONS Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. MAIN OUTCOMES AND MEASURESThe primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction.RESULTS A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). CONCLUSIONS AND RELEVANCEIn this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.

miRNA-126-3p carried by human umbilical cord mesenchymal stem cell enhances endothelial function through exosome-mediated mechanisms in vitro and attenuates vein graft neointimal formation in vivo

“…Up to 50% of the autogenous vein will be restenosis or occluded during the first 10 years after CABG, leading to recurrent symptoms, myocardial infarction, or reoperative revascularization [ 2 ]. Currently, there is no effective treatment strategy for vein graft restenosis.…”

“…The vein graft model and hucMSC transplantation were performed by using our previously described methods [ 18 , 19 ]. Briefly, rats were randomly divided into 5 groups as follows: [ 1 ] sham group, [ 2 ] vein graft group, [ 3 ] vein graft+hucMSCs group (hucMSCs group), [ 4 ] vein graft+GFP-hucMSCs group (GFP-hucMSCs group), and [ 5 ] vein graft+miRNA-126-3p-hucMSCs group (miRNA-126-3p-hucMSCs group). End-to-end anastomosis using “cuff technology” was performed to establish arteriovenous bypass grafting model in the vein graft group and all three hucMSC transplantation groups.…”

“…For CABG, the autogenous great saphenous vein is the most widely used vascular graft [ 1 ]. However, more than half of vein grafts will be occluded during the first 10 years after CABG [ 2 ]. The restenosis caused by vein graft intimal hyperplasia has become a key factor influencing the efficacy of CABG.…”

Radial Artery Access

“…Radial artery is being reinvestigated as a favored coronary artery bypass graft (CABG) over veins with recent meta analysis of 1036 patients having lower mortality with arterial grafts over venous grafts [38]. This has prompted the ROMA prospective randomized trial comparing vein to arterial grafts for CABG.…”

miRNA-126-3p Carried by Human Umbilical Cord Mesenchymal Stem Cell Enhances Endothelial Function through Exosome-mediated Mechanisms in Vitro and Attenuates Vein Grafts Neointimal Formation in Vivo

“…For CABG, the autogenous great saphenous vein is the most widely used vascular graft 1 . However, more than half of vein grafts will be occluded during the rst ten years after CABG 2 . The restenosis caused by vein graft intimal hyperplasia has become a key factor in uencing the e cacy of CABG.…”