Long-Term Results of the RAPCO Trials
Long-Term Results of the RAPCO Trials
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DOI：
10.1161/circulationaha.119.045427
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发表时间：
2020-10-06
期刊：
影响因子：
37.8
通讯作者：
Hare, David L.
中科院分区：
文献类型：
--
作者：
Buxton, Brian F.;Hayward, Philip A.;Hare, David L.
背景：将胸廓内动脉移植到左前降支是冠状动脉搭桥手术的标准做法，但最佳第二导管存在争议。 RAPCO 试验（桡动脉通畅和临床结果）旨在比较桡动脉 (RA) 与右胸廓内动脉 (RITA) 和隐静脉 (SV) 的长期通畅性。 方法：在 RAPCO-RITA（RAPCO 试验的 RITA 与 RA 组）中，394 名患有糖尿病的患者（年龄 = 60 岁）被随机分配接受 RA 或SV移植。主要结局是 10 年移植失败。长期死亡率是一个无动力的共同主要终点。主要分析是按意向治疗进行的。结果：在 RA 与 RITA 比较中，RA 的估计 10 年通畅率为 89%，而游离 RITA 为 80%（移植失败的风险比，0.45 [95% CI，0.23-0.88]）。 RA 组的十年患者生存率为 90.9%，而 RITA 组为 83.7%（死亡率风险比，0.53 [95% CI，0.30-0.95]）。在 RA 与 SV 比较中，RA 组的估计 10 年通畅率为 85%，SV 组为 71%（移植失败的风险比，0.40 [95% CI，0.15-1.00]），RA 组的 10 年患者生存率估计为 72.6%，而 SV 组为 65.2%（死亡率的风险比，0.76 [95%]） CI, 0.47-1.22]）。结论：RA 的 10 年通畅率显着高于游离 RITA，且优于 SV。
BACKGROUND: An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV).METHODS: In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients = 60 years of age if they had diabetes mellitus) were randomized to receive RA or SV graft. The primary outcome was 10-year graft failure. Long-term mortality was a nonpowered coprimary end point. The main analysis was by intention to treat.RESULTS: In the RA versus RITA comparison, the estimated 10-year patency was 89% for RA versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI, 0.23-0.88]). Ten-year patient survival estimate was 90.9% in the RA arm versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI, 0.30-0.95]). In the RA versus SV comparison, the estimated 10-year patency was 85% for the RA versus 71% for the SV (hazard ratio for graft failure, 0.40 [95% CI, 0.15-1.00]), and 10-year patient survival estimate was 72.6% for the RA group versus 65.2% for the SV group (hazard ratio for mortality, 0.76 [95% CI, 0.47-1.22]).CONCLUSIONS: The 10-year patency rate of the RA is significantly higher than that of the free RITA and better than that of the SV.