Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Am J Cardiol. 2024 Mar 1;214:33-39. doi: 10.1016/j.amjcard.2023.12.047. Epub 2024 Jan 5.
Despite the advantages of multiarterial grafting, saphenous vein (SV) configurations predominate in coronary artery bypass grafting (CABG). In addition, the benefits of radial artery (RA) utilization in multivessel CABG remain unclear. This study aims to compare the clinical outcomes of patients who received RA grafts during CABG with those of patients who received SV grafts. A retrospective, single-institution cohort study was performed in 8,774 adults who underwent isolated CABG surgery with multiple grafts between 2010 and 2022. To balance graft cohorts, propensity score matching (PSM) was performed using a 1:2 (RA/SV) match ratio. Long-term postoperative survival was compared in RA and SV graft groups. Similarly, major adverse cardiac and cerebrovascular event (MACCE) rates were compared in the cohorts, with MACCE comprising death, myocardial infarction (MI), coronary revascularization, and stroke. Kaplan-Meier estimation was performed for both mortality and MACCE. A total of 7,218 patients (82.3%) who underwent multivessel CABG were included in this analysis. Of these patients, 341 (4.7%) received RA grafts, and 6,877 (95.3%) received SV grafts secondary to left internal mammary artery use. PSM yielded a cohort of 335 patients with RA and 670 patients with SV. After matching, groups were well balanced across all baseline variables. No significant differences were observed in either immediate postoperative morbidities or long-term survival. However, Kaplan-Meier estimates of long-term postoperative freedom from MACCE were significantly greater in matched patients with SV (73.3%) than in those with RA (67.4%) (p = 0.044, cluster log-rank), with patients with SV also possessing significantly greater freedom from coronary revascularization and MI. In conclusion, RA and SV secondary conduits for CABG were associated with comparable immediate postoperative complications and long-term survival after PSM. SV grafting was associated with significantly decreased rates of postoperative MACCE, likely owing to lower rates of coronary revascularization and MI than in RA grafting.
尽管多动脉吻合具有优势，但在冠状动脉旁路移植术（CABG）中，大隐静脉（SV）的应用仍然占主导地位。此外，桡动脉（RA）在多血管 CABG 中的应用益处仍不明确。本研究旨在比较接受 CABG 中 RA 移植的患者与接受 SV 移植的患者的临床结局。这是一项回顾性的单中心队列研究，纳入了 2010 年至 2022 年期间接受多支血管 CABG 手术且使用多支移植物的 8774 名成年人。为了平衡移植物队列，使用 1:2（RA/SV）匹配比进行倾向评分匹配（PSM）。比较 RA 和 SV 移植组的长期术后生存情况。同样，在队列中比较主要不良心脑血管事件（MACCE）发生率，MACCE 包括死亡、心肌梗死（MI）、冠状动脉血运重建和中风。对死亡率和 MACCE 进行 Kaplan-Meier 估计。共有 7218 名（82.3%）接受多血管 CABG 的患者纳入本分析。其中，341 名（4.7%）患者接受 RA 移植，6877 名（95.3%）患者因左内乳动脉使用而接受 SV 移植。PSM 产生了一组 335 名 RA 患者和 670 名 SV 患者。匹配后，两组在所有基线变量上均均衡。两组患者术后即刻并发症和长期生存无显著差异。然而，在匹配患者中，SV 组的长期术后 MACCE 无事件生存率（73.3%）明显高于 RA 组（67.4%）（p=0.044，簇对数秩检验），SV 组患者的冠状动脉血运重建和 MI 无事件生存率也明显更高。总之，CABG 的 RA 和 SV 次级移植物与 PSM 后的即刻术后并发症和长期生存相关。SV 移植与术后 MACCE 发生率显著降低相关，可能是由于冠状动脉血运重建和 MI 发生率低于 RA 移植。
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