TAILIEUCHUNG - A Randomized Comparison of Radial-Artery and Saphenous-Vein Coronary Bypass Grafts

In the past decade, the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a randomized trial in which we controlled for bias in the selection of patients and vessels. methods We enrolled 561 patients at 13 centers. The left internal thoracic artery was used to bypass the anterior circulation | A Randomized Comparison of Radial-Artery and Saphenous-Vein Coronary Bypass Grafts A Randomized Comparison of Radial-Artery and Saphenous-Vein Coronary Bypass Grafts Nimesh D. Desai . Eric A. Cohen . C. David Naylor . . and Stephen E. Fremes . for the Radial Artery Patency Study Investigators abstract From the Divisions of Cardiac Surgery . . Cardiology . and General Internal Medicine . Sunny-brook and Women s College Health Sciences Centre University of Toronto Toronto. Address reprint requests to Dr. Fremes at Sunnybrook and Women s College Health Sciences Centre Rm. H410 2075 Bayview Ave. Toronto ON M4N 3M5 Canada or at . N Engl J Med 2004 351 2302-9. Copyright 2004 Massachusetts Medical Society. background In the past decade the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a randomized trial in which we controlled for bias in the selection of patients and vessels. methods We enrolled 561 patients at 13 centers. The left internal thoracic artery was used to bypass the anterior circulation. The radial-artery graft was randomly assigned to bypass the major vessel in either the inferior right coronary territory or the lateral circumflex territory with the saphenous-vein graft used for the opposing territory control . The primary end point was graft occlusion determined by angiography 8 to 12 months postoperatively. results Angiography was performed at one year in 440 patients percent of radial-artery grafts and percent ofsaphenous-vein grafts were completely occluded P . Diffuse narrowing of the graft the angiographic string sign was present in percent of radial-artery grafts and only percent of saphenous-vein grafts P . The absence of severe

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