The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia;
Ann Cardiothorac Surg. 2013 Jul;2(4):401-7. doi: 10.3978/j.issn.2225-319X.2013.07.03.
Currently, saphenous vein (SV) and radial artery (RA) are the most commonly used conduits in combination with the left internal mammary artery for conventional coronary artery bypass graft surgery (CABG). The present meta-analysis aimed to assess the existing evidence from randomized controlled trials (RCTs) to compare the angiographic outcomes of these two conduits at mid-term follow-up.
Four relevant and updated RCTs with follow-up beyond 3 years were identified using five electronic databases. Angiographic endpoints included complete occlusion, 'string sign', graft failure and complete patency.
The incidence of complete occlusion was significantly lower after using RA compared to SV [6.7% vs. 17.2%; odd ratio (OR), 0.36; 95% confidence interval (CI), 0.23-0.58; P<0.0001]. The angiographic 'string sign' was significantly more likely to be identified after using RA compared to SV (3.1% vs. 0%; OR, 5.65; 95% CI, 1.21-26.39; P=0.03). Graft failure was significantly lower after RA compared to SV (9.6% vs. 18.8%; OR, 0.47; 95% CI, 0.30-0.72; P=0.0005). Complete graft patency was found to be significantly higher after RA compared to SV (88.6% vs. 75.8%; OR, 3.19; 95% CI, 1.42-7.16; P=0.005).
Results of the present meta-analysis suggest that selected patients with severe, proximal stenosis may have superior angiographic outcomes at mid-term follow-up after using RA compared to SV for CABG. However, RA is associated with a significantly higher incidence of the 'string sign'. Future studies should aim to collect additional data on symptomatic outcomes.
目前，大隐静脉（SV）和桡动脉（RA）是与左内乳动脉联合进行常规冠状动脉旁路移植术（CABG）时最常使用的血管移植物。本荟萃分析旨在评估来自随机对照试验（RCT）的现有证据，以比较这两种移植物在中期随访时的血管造影结果。
使用五个电子数据库确定了四项具有 3 年以上随访的相关且更新的 RCT。血管造影终点包括完全闭塞、“线样征”、移植物失败和完全通畅。
与 SV 相比，RA 的完全闭塞发生率显著降低[6.7%比 17.2%；比值比（OR）为 0.36；95%置信区间（CI）为 0.23-0.58；P<0.0001]。与 SV 相比，RA 的血管造影“线样征”更有可能被识别[3.1%比 0%；OR 为 5.65；95%CI 为 1.21-26.39；P=0.03]。RA 的移植物失败发生率显著低于 SV[9.6%比 18.8%；OR 为 0.47；95%CI 为 0.30-0.72；P=0.0005]。RA 的完全通畅率显著高于 SV[88.6%比 75.8%；OR 为 3.19；95%CI 为 1.42-7.16；P=0.005]。
本荟萃分析的结果表明，与 SV 相比，对于 CABG，患有严重、近端狭窄的选定患者在中期随访时可能具有更好的血管造影结果。然而，RA 与“线样征”的发生率显著升高相关。未来的研究应旨在收集关于症状性结果的额外数据。
