Choice of Conduit for the Right Coronary System: 8-Year Analysis of Radial Artery Patency and Clinical Outcomes Trial
Choice of Conduit for the Right Coronary System: 8-Year Analysis of Radial Artery Patency and Clinical Outcomes Trial
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DOI：
10.1016/j.athoracsur.2009.06.010
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发表时间：
2009-11-01
影响因子：
4.6
通讯作者：
Buxton, Brian F.
中科院分区：
文献类型：
--
作者：
Hadinata, Ignatius E.;Hayward, Philip A. R.;Buxton, Brian F.
背景资料。以前的报告支持使用双侧胸腔内动脉来重建左冠状动脉循环。如果这成为标准做法，右冠状动脉系统的最佳管道仍有待建立。我们的目的是比较在初次冠状动脉搭桥术后的8年内，使用桡动脉和大隐静脉移植右冠状动脉或其分支时的表现。桡动脉通畅性和临床结果研究是一项随机对照试验，比较了桡动脉、隐静脉和游离的右侧胸腔内动脉。在参与这项研究的621名患者中，465名患者接受了右冠状动脉或其分支的移植。采用回顾性汇编的数据库建立这些患者的通畅率和临床事件。移植物的绝对通畅率如下：桡动脉，68例，86.9%(95%可信区间，76.6%~93.1%)；大隐静脉，197例，81.2%(95%可信区间，75.1%~86.1%)。非劣性检验表明，放射状血管对大隐动脉的绝对通畅率至少为0.9526(p=0.025)。Kaplan-Meier对血管造影术结果的估计显示没有显著差异(对数等级p=0.22)。右冠脉内发生心脏事件的发生率为1.79%，大隐静脉组为4.93%，P=0.26。总死亡率：桡动脉组8.03%，大隐静脉组12.5%(p=0.23)。当移植到右冠状动脉或其分支时，桡动脉的通畅率至少与大隐静脉的通畅率相当。值得注意的是，两种移植物的临床事件都很少。因此，最佳管道的选择可以根据其他因素进行。(Ann Thorac Surg 2009；88：1404-9)(C)由胸外科学会于2009年出版
Background. Previous reports have supported the use of bilateral internal thoracic arteries to revascularize the left coronary circulation. If this becomes standardized practice, the optimal conduit for the right coronary system remains to be established. Our objective is to compare the performance of the radial artery versus the saphenous vein when used to graft the right coronary artery or its branches during an 8-year period after primary coronary artery bypass graft surgery.Methods. The Radial Artery Patency and Clinical Outcomes study is a randomized controlled trial comparing radial artery, saphenous vein, and free right internal thoracic artery. Of the 621 patients enrolled in the study, 465 patients received a graft to the right coronary artery or its branches. The retrospectively compiled database was used to establish patency rates and clinical events among these patients.Results. Absolute graft patency rates were as follows: radial artery, 86.9% of 68 (95% confidence interval, 76.6% to 93.1%); and saphenous vein, 81.2% of 197 (95% confidence interval, 75.1% to 86.1%). Noninferiority tests show that absolute radial patency to saphenous patency is at least 0.9526 (p = 0.025). Kaplan-Meier estimates of angio-graphic outcomes show no significant difference (log rank p = 0.22). Cardiac events in the right coronary territory occurred in the radial artery group (1.79%) versus the saphenous vein group (4.93%; p = 0.26). Overall mortality was 8.03% in the radial artery group versus 12.5% in the saphenous vein group (p = 0.23).Conclusions. The radial artery patency is at least comparable to that of the saphenous vein when grafted to the right coronary artery or its branches. The paucity of clinical events in both grafts is notable. Selection of best conduit may therefore be made according to other factors. (Ann Thorac Surg 2009;88:1404-9) (C) 2009 by The Society of Thoracic Surgeons