Department of Surgery, University of Toledo Medical Center, Toledo, Ohio; Mercy Saint Vincent Medical Center, Toledo, Ohio.
Beth Israel Medical Center, New York, New York.
Ann Thorac Surg. 2014 Apr;97(4):1328-34; discussion 1334. doi: 10.1016/j.athoracsur.2013.09.096. Epub 2013 Dec 17.
A survival benefit of radial artery use versus saphenous vein grafting in coronary artery bypass grafting (CABG) has been reported. We aimed to elucidate the relative radial artery survival benefit as a function of time after surgery from two independent CABG series.
We compared 0- to 15-year survival with radial artery versus saphenous vein grafting in isolated, nonsalvage primary CABG with left internal thoracic artery to left anterior descending from two institutions: Ohio (radial artery [n=2,361; 61 years]; saphenous vein [n=2,547; 67 years]), and New York (radial artery [n=1,970; 58 years]; saphenous vein [n=2,974; 69 years]). Separate multivariate radial artery-use propensity models based on demographic, preoperative factors, intraoperative variables, and completeness of revascularization data were computed and used to derive propensity- and sex-matched CABG cohorts (1,799 [Ohio] and 995 [New York] pairs). A three-phase (early and late) mortality model was fit to Kaplan-Meier mortality estimates and used to derive relative radial artery versus saphenous vein hazard functions.
Radial artery use patterns and patient risk profiles differed substantially for New York and Ohio, with the New York radial artery cohort significantly younger and more male. Within-institution matched graft-type cohorts were well matched. Cumulative mortality was significantly better for radial artery at both institutions (p < 0.001 both). All mortality-time data were well described by the three-phase model, and the derived relative hazard functions were qualitatively and quantitatively similar for New York and Ohio, exhibiting maximal benefit between 0.5 and 5 years.
Despite substantial differences in radial artery use patterns during a 15-year period, our analysis in large propensity-matched radial artery and saphenous vein cohorts yielded remarkably similar, time-varying radial artery to saphenous vein survival benefit at both institutions. These converging findings based on two independent patient series extend currently available objective evidence in support of a radial artery survival advantage in CABG.
已有研究报道，在冠状动脉旁路移植术（CABG）中，桡动脉的使用相较于隐静脉移植物具有生存获益。我们旨在阐明从两个独立的 CABG 系列中，手术后桡动脉的相对生存获益随时间的变化。
我们比较了两个机构的孤立、非挽救性原发性 CABG 中桡动脉与隐静脉的 0-15 年生存情况：俄亥俄州（桡动脉[2361 例；61 岁]，隐静脉[2547 例；67 岁]）和纽约州（桡动脉[1970 例；58 岁]，隐静脉[2974 例；69 岁]）。根据人口统计学、术前因素、术中变量和血运重建完整度数据，分别计算了基于桡动脉使用的多变量倾向模型，并利用该模型得出倾向匹配和性别匹配的 CABG 队列（俄亥俄州 1799 对，纽约州 995 对）。采用三期（早期和晚期）死亡率模型拟合 Kaplan-Meier 死亡率估计，并利用该模型得出桡动脉与隐静脉的相对危险函数。
纽约州和俄亥俄州的桡动脉使用模式和患者风险特征存在显著差异，纽约州的桡动脉队列年龄更小，男性更多。机构内的匹配移植物类型队列匹配良好。两个机构的桡动脉组累积死亡率均显著更低（均<0.001）。三期模型能够很好地描述所有的死亡时间数据，且纽约州和俄亥俄州的相对危险函数具有相似的定性和定量特征，在 0.5 至 5 年之间达到最大获益。
尽管在 15 年期间桡动脉的使用模式存在显著差异，但我们对大型倾向匹配的桡动脉和隐静脉队列进行的分析得出，两个机构的桡动脉与隐静脉的生存获益均随时间发生变化，且非常相似。基于两个独立的患者系列的这些趋同发现，为 CABG 中桡动脉的生存优势提供了目前可用的客观证据。
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