Does the addition of a radial artery improve survival in higher risk coronary artery bypass grafting?.

Objectives: The use of the radial artery as a second arterial graft during coronary surgery has become popular due to high patency and low harvest site complication rates. We sought to assess whether higher-risk patients derive such benefits. Method(s): From 2001 to 2009, 11 388 patients underwent isolated primary multivessel coronary surgery. We identified a higher risk subgroup (n=2581) according to urgency status, coronary instability, low ejection fraction and/ or aortic counterpulsation. Among these, 1832 (71%) received at least one radial artery graft in addition to a left internal thoracic artery (LITA). The remaining 749 (29%) received LITA and veins only. Result(s): Patients not receiving a radial artery were more likely to be elderly, female, have poor left ventricular function or be of emergency status. These patients experienced higher unadjusted 30-day mortality (radial 2% vs vein 8%, P<0.0001) with lower unadjusted 7-year survival (80+/-1.3% vs 67+/-2.4%, P<0.0001). Subsequently, 515 patients in the radial group were propensitymatched to 515 receiving only veins (mean logistic EuroSCORE, radial 19+/-14% vs vein 19+/-13%, P=0.87). At 30 days, there were comparable rates of mortality (radial 4% vs vein 3%, P>0.99), stroke (1% vs 1%, P>0.99), myocardial infarction (1% vs 2%, P=0.79), and any morbidity/mortality (34% vs 35%, P=0.95). At seven years, survival of radial and vein groups was similar (radial 75+/-2.6% vs vein 74+/-2.9%, P=0.65). Conclusion(s): Patients with the greatest coronary instability, urgency of surgery, or impairment of ventricular function are not disadvantaged in early outcomes or mid-term survival by use of only a single arterial graft.