From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.).
Circulation. 2017 Aug 1;136(5):454-463. doi: 10.1161/CIRCULATIONAHA.117.027659. Epub 2017 May 31.
Whether the use of the radial artery (RA) can improve clinical outcomes in coronary artery bypass graft surgery remains unclear. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral internal thoracic artery (BITA) over single left internal thoracic artery (SITA). In the ART, a large proportion of patients (≈20%) also received an RA graft instead of a saphenous vein graft (SVG). We aimed to investigate the associations between using the RA instead of an SVG to supplement SITA or BITA grafts and outcomes by performing a post hoc analysis of the ART.
Patients enrolled in the ART (n=3102) were classified on the basis of conduits actually received (as treated). The analysis included 2737 patients who received an RA graft (RA group; n=632) or SVG only (SVG group; n=2105) in addition to SITA or BITA grafts. The primary end point was the composite of myocardial infarction, cardiovascular death, and repeat revascularization at 5 years. Propensity score matching and stratified Cox regression were used to compare the 2 strategies.
Myocardial infarction, cardiovascular death, and repeat revascularization cumulative incidence was 2.3% (95% confidence interval [CI], 1.1-3.4), 3.5% (95% CI, 2.1-5.0), and 4.4% (95% CI, 2.8-6.0) in the RA group and 3.4% (95% CI, 2.0-4.8), 4.0% (95% CI, 2.5-5.6), and 7.6% (95% CI, 5.5-9.7) in the SVG group, respectively. The composite end point was significantly lower in the RA group (8.8%; 95% CI, 6.5-11.0) compared with the SVG group (13.6%; 95% CI, 10.8-16.3; =0.005). This association was present when an RA graft was used to supplement both SITA and BITA grafts (interaction =0.62).
This post hoc ART analysis showed that an additional RA was associated with lower risk for midterm major adverse cardiac events when used to supplement SITA or BITA grafts.
URL: https://www.situ.ox.ac.uk/surgical-trials/art. Unique identifier: ISRCTN46552265.
在冠状动脉旁路移植术中，使用桡动脉（RA）是否能改善临床结局尚不清楚。ART（动脉再血管化试验）旨在比较双侧内乳动脉（BITA）与单根左内乳动脉（SITA）的生存情况。在 ART 中，很大一部分患者（约 20%）还接受了 RA 移植物而不是大隐静脉移植物（SVG）。我们旨在通过对 ART 的事后分析，研究用 RA 代替 SVG 来补充 SITA 或 BITA 移植物与结局之间的关系。
根据实际接受的导管（按治疗分类），对 ART 中纳入的 3102 名患者进行分类。分析包括 2737 名患者，他们除了接受 SITA 或 BITA 移植物外，还接受了 RA 移植物（RA 组；n=632）或 SVG 移植物（SVG 组；n=2105）。主要终点是 5 年内心肌梗死、心血管死亡和再次血运重建的复合终点。采用倾向评分匹配和分层 Cox 回归比较两种策略。
RA 组心肌梗死、心血管死亡和再次血运重建的累积发生率分别为 2.3%（95%可信区间[CI]，1.1-3.4）、3.5%（95% CI，2.1-5.0）和 4.4%（95% CI，2.8-6.0），SVG 组分别为 3.4%（95% CI，2.0-4.8）、4.0%（95% CI，2.5-5.6）和 7.6%（95% CI，5.5-9.7）。RA 组复合终点明显低于 SVG 组（8.8%；95% CI，6.5-11.0 比 13.6%；95% CI，10.8-16.3；=0.005）。当 RA 移植物用于补充 SITA 和 BITA 移植物时，这种关联仍然存在（交互作用=0.62）。
ART 事后分析显示，当用于补充 SITA 或 BITA 移植物时，附加 RA 与中期主要不良心脏事件的风险降低相关。
网址：https://www.situ.ox.ac.uk/surgical-trials/art。唯一标识符：ISRCTN46552265。
