Department of Cardiac Surgery, Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK.
Eur J Cardiothorac Surg. 2017 Feb 1;51(2):376-381. doi: 10.1093/ejcts/ezw323.
The radial artery (RA) is often used as a second arterial conduit in preference to the right internal thoracic artery in obese patients undergoing coronary artery bypass grafting (CABG) to minimise the risk of sternal wound complication. However, obesity has been found to promote RA vasoreactivity and early atherosclerotic degeneration, which may compromise graft patency when used in patients having CABG. Therefore, we investigated the effect of the RA as a second conduit compared with the saphenous vein (SV) on long-term survival in obese and non-obese patients undergoing first-time CABG. Propensity score matching was used to adjust for imbalance, and the effect of the RA in obese (body mass index, BMI ≥ 30) and non-obese (BMI < 30) participants was tested by means of time-segmented Cox regression. The study population comprised 12 244 patients undergoing first-time CABG. Of those, 8740 patients were non-obese and 3504 were obese. The RA was used as a second arterial conduit in 1322 (15%) non-obese patients and in 685 (20%) obese patients. The use of the RA compared to the SV reduced the risk of late death in patients with BMI < 30 (HR 0.78; 95% CI 0.65–0.94; = 0.008) but not in those with BMI ≥ 30 (HR 1.05; 95% CI 0.80–1.38; = 0.72), regardless of their diabetes status (non-diabetic HR 0.87 [0.63–1.20] vs diabetic HR 0.83 [0.54–1.26]; interaction = 0.8). The use of the RA in preference to the SV as a second conduit was associated with improved long-term survival in non-obese patients undergoing CABG. This benefit was no longer present in obese patients regardless of their diabetes status.
桡动脉（RA）通常被用作第二种动脉导管，而不是右侧胸廓内动脉，用于接受冠状动脉旁路移植术（CABG）的肥胖患者，以最大程度地降低胸骨伤口并发症的风险。然而，已经发现肥胖会促进 RA 血管反应性和早期动脉粥样硬化退化，这可能会影响 CABG 患者的移植物通畅性。因此，我们研究了在接受首次 CABG 的肥胖和非肥胖患者中，将 RA 用作第二种导管与隐静脉（SV）相比对长期生存率的影响。使用倾向评分匹配来调整不平衡，并用时间分段 Cox 回归测试 RA 在肥胖（体重指数，BMI≥30）和非肥胖（BMI<30）患者中的作用。 研究人群包括 12244 名接受首次 CABG 的患者。其中，8740 名患者非肥胖，3504 名患者肥胖。在 1322 名（15%）非肥胖患者和 685 名（20%）肥胖患者中，RA 被用作第二种动脉导管。与 SV 相比，RA 的使用降低了 BMI<30 的患者发生晚期死亡的风险（HR 0.78；95%CI 0.65-0.94；P=0.008），但在 BMI≥30 的患者中没有降低（HR 1.05；95%CI 0.80-1.38；P=0.72），无论他们是否患有糖尿病（非糖尿病 HR 0.87 [0.63-1.20] vs 糖尿病 HR 0.83 [0.54-1.26]；交互作用 P=0.8）。与 SV 相比，在 CABG 中，将 RA 作为第二种导管使用与非肥胖患者的长期生存率提高相关。无论其糖尿病状况如何，这种益处都不再存在于肥胖患者中。
