RAPCO 试验的长期结果。
Long-Term Results of the RAPCO Trials.
机构信息
Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia (B.F.B., J.R., S.C.M., S.S., G.M.).
Faculty of Medicine, Dentistry and Health Sciences (B.F.B., P.A.H., J.R., A.R., S.S., G.M., D.L.H.), University of Melbourne, Australia.
出版信息
Circulation. 2020 Oct 6;142(14):1330-1338. doi: 10.1161/CIRCULATIONAHA.119.045427. Epub 2020 Oct 5.
BACKGROUND
An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV).
METHODS
In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or <60 years of age if they had diabetes mellitus) were randomized to receive RA or free RITA graft on the second most important coronary target. In RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients ≥70 years of age (or ≥60 years of age if they had diabetes mellitus) were randomized to receive RA or SV graft. The primary outcome was 10-year graft failure. Long-term mortality was a nonpowered coprimary end point. The main analysis was by intention to treat.
RESULTS
In the RA versus RITA comparison, the estimated 10-year patency was 89% for RA versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI, 0.23-0.88]). Ten-year patient survival estimate was 90.9% in the RA arm versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI, 0.30-0.95]). In the RA versus SV comparison, the estimated 10-year patency was 85% for the RA versus 71% for the SV (hazard ratio for graft failure, 0.40 [95% CI, 0.15-1.00]), and 10-year patient survival estimate was 72.6% for the RA group versus 65.2% for the SV group (hazard ratio for mortality, 0.76 [95% CI, 0.47-1.22]).
CONCLUSIONS
The 10-year patency rate of the RA is significantly higher than that of the free RITA and better than that of the SV. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00475488.
背景
在冠状动脉旁路移植术中，将内乳动脉移植物移植到左前降支是标准的，但对于最佳的第二种移植物仍存在争议。RAPCO 试验（桡动脉通畅性和临床结果）旨在比较桡动脉（RA）与右内乳动脉（RITA）和隐静脉（SV）的长期通畅率。
方法
在 RAPCO-RITA 试验（RAPCO 试验中 RITA 与 RA 分支）中，394 名年龄<70 岁（或<60 岁且患有糖尿病）的患者被随机分配接受第二重要冠状动脉靶目标的 RA 或游离 RITA 移植物。在 RAPCO-SV 试验（RAPCO 试验中 RA 与 SV 分支）中，225 名年龄≥70 岁（或≥60 岁且患有糖尿病）的患者被随机分配接受 RA 或 SV 移植物。主要结局为 10 年移植物失败。长期死亡率是一个非主要终点。主要分析为意向治疗。
结果
在 RA 与 RITA 的比较中，RA 的 10 年通畅率估计为 89%，而游离 RITA 为 80%（移植物失败的风险比为 0.45[95%CI，0.23-0.88]）。RA 组的 10 年患者生存率估计为 90.9%，而 RITA 组为 83.7%（死亡率的风险比为 0.53[95%CI，0.30-0.95]）。在 RA 与 SV 的比较中，RA 的 10 年通畅率估计为 85%，而 SV 的 71%（移植物失败的风险比为 0.40[95%CI，0.15-1.00]），RA 组的 10 年患者生存率估计为 72.6%，SV 组为 65.2%（死亡率的风险比为 0.76[95%CI，0.47-1.22]）。
结论
RA 的 10 年通畅率明显高于游离 RITA，优于 SV。
注册
网址：https://www.clinicaltrials.gov；唯一标识符：NCT00475488。
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