Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, CA.
J Am Heart Assoc. 2013 Aug 22;2(4):e000266. doi: 10.1161/JAHA.113.000266.
The clinical benefits of the left internal thoracic artery-to-left anterior descending coronary artery graft are well established in coronary artery bypass graft surgery (CABG). However, limited data are available regarding the long-term outcome of the radial artery (RA) as a secondary conduit over the established standard of the saphenous venous graft.
We compared the 12-year survival outcome in a set of propensity-matched CABG patients who received either the RA or the saphenous vein as a secondary conduit. A multivariable logistic regression that included 18 baseline characteristics was used to define the propensity of receiving an RA graft. The propensity model resulted in 260 matched pairs who underwent first-time isolated CABG from 1996 to 2001 with similar preoperative characteristics (C statistic=0.86). The cumulative 12-year survival estimated by use of the Kaplan-Meier method was higher for the RA graft patients (hazard ratio 0.76; P=0.03). This survival advantage was especially significant in diabetics (P=0.005), in women (P=0.02), and in the elderly (P=0.04.) The protective effect appeared beginning at year 5 post surgical intervention.
The RA as a secondary conduit provided superior long-term survival after CABG, especially in diabetic patients, women, and the elderly. This effect was most pronounced >5 years after surgery.
左内乳动脉至左前降支冠状动脉搭桥术在冠状动脉旁路移植术（CABG）中具有良好的临床获益。然而，关于桡动脉（RA）作为次级移植物的长期结果的数据有限，而 RA 是公认的隐静脉移植物的标准。
我们比较了一组接受 RA 或隐静脉作为次级移植物的 CABG 患者的 12 年生存结果。使用包含 18 个基线特征的多变量逻辑回归来确定接受 RA 移植物的倾向。该倾向模型得出了 260 对在 1996 年至 2001 年期间接受首次孤立 CABG 的匹配患者，其术前特征相似（C 统计量=0.86）。Kaplan-Meier 方法估计的 12 年累积生存率对 RA 移植患者更高（风险比 0.76；P=0.03）。这种生存优势在糖尿病患者中更为显著（P=0.005），在女性中（P=0.02）和在老年人中（P=0.04）。这种保护作用在术后 5 年开始显现。
RA 作为次级移植物在 CABG 后提供了更好的长期生存，尤其是在糖尿病患者、女性和老年人中。这种效果在手术后 5 年以上最为明显。
