Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study

Right Internal Thoracic Artery for Coronary Bypass Surgery: Did We Get It Wrong?

“…In an angiographic analysis of 6 CABG trials, the 5-year occlusion rate of the RITA was 13.5%, 2 and in a post hoc analysis of the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) CABG study, the RITA failure rate at 1 year was 26.8%. 3 Although these analyses included a relatively small number of grafts, they were based on prospective imaging follow-up within the context of a randomized trial, with a lower risk of bias compared with observational series. In addition, the RAPCO trial (Radial Artery Patency and Clinical Outcomes) showed, at 10 years of follow-up, that the occlusion rate of the free RITA was significantly higher than that of the RA (20% versus 11%).…”

Commentary: Conduit selection in the COMPASS trial: Pointing in the wrong direction?

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The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) investigators report 1-year computed tomography angiography patency rates of 4 different coronary artery bypass graft conduits. 1 In the overall study, 1068 patients received 3480 grafts, or an average of 3.3 grafts per patient. 1 The operations were performed by more than 100 surgeons in 83 centers in 22 countries.

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“…1 In the overall study, 1068 patients received 3480 grafts, or an average of 3.3 grafts per patient. 1 The operations were performed by more than 100 surgeons in 83 centers in 22 countries. 1 Overall, there were 2239 saphenous vein grafts (SVGs) (64%), 1068 left internal thoracic artery (LITA) grafts (31%), 90 radial artery (RA) grafts (2.6%), and 82 right internal thoracic artery (RITA) grafts (2.4%).…”

“…Accordingly, in both the Conclusions and the Perspective Statement (ie, the take-home messages), the authors state "high rates of RITA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of RITA in coronary artery bypass graft surgery." 1 Are these very alarmist statements actually justifiable based on the evidence presented? To place the COMPASS findings into perspective, 3 questions require addressing to explain a near 5-fold difference in LITA and RITA graft patency:…”

Author Reply to Commentary: Conduit selection in the COMPASS trial: Pointing in the right direction

“…In this issue, our colleague Dr David Taggart 1 is presenting a commentary on our recent publication, 2 concluding "Rather than the alarmist message of the investigators, implying an intrinsic biological/mechanistic problem with the RIMA graft, perhaps their real message is that 'a good vein graft is much better than a poorly harvested/deployed RIMA graft.'" I believe that he is pointing in the wrong direction.…”