Wang Chunyuan, Tian Meice, Wang Yang, Song Lei, Hou Zhihui, Chen Sipeng, Feng Wei, Zhang Yan, Hu Zhan
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
JTCVS Open. 2025 Feb 12;24:206-216. doi: 10.1016/j.xjon.2025.01.019. eCollection 2025 Apr.
Radial artery grafts and saphenous vein grafts exhibit heterogeneous responses to competitive flow, a phenomenon assessable through quantitative flow ratio. The present study aims to compare the patency of radial artery and saphenous vein grafts across various quantitative flow ratio ranges.
The clinical data and quantitative flow ratio values for each target vessel were retrospectively collected in patients receiving radial artery or conventional saphenous vein grafts in our center from 2017 to 2021. The primary outcome was graft occlusion assessed by coronary computed tomography angiography and coronary angiography, and the secondary outcome was major adverse cardiac or cerebrovascular events. Mixed-effect multivariable Cox regression models were used to assess the independent effect of graft conduit type and quantitative flow ratio on graft occlusion.
A total of 1314 patients with 292 radial artery target vessels and 1736 saphenous vein graft target vessels were included. The median follow-up duration was 3 years. Quantitative flow ratio value of 0.57 was identified as the optimal threshold. Compared with saphenous vein graft, the radial artery exhibited lower patency in target vessels where quantitative flow ratio was greater than 0.57 (adjusted hazard ratio, 4.63, 95% CI, 2.61-8.21, < .001), but higher patency in vessels in which the quantitative flow ratio was 0.57 or less (adjusted hazard ratio, 0.14, 95% CI, 0.03-0.68, = .015).
Radial artery grafts may achieve superior patency in target vessels with low quantitative flow ratio values, whereas saphenous vein grafts may be associated with higher short-term patency in vessels with higher quantitative flow ratio values.
桡动脉移植物和大隐静脉移植物对竞争性血流表现出异质性反应，这一现象可通过定量血流比率进行评估。本研究旨在比较不同定量血流比率范围内桡动脉和大隐静脉移植物的通畅率。
回顾性收集2017年至2021年在本中心接受桡动脉或传统大隐静脉移植物的患者的每条靶血管的临床数据和定量血流比率值。主要结局是通过冠状动脉计算机断层扫描血管造影和冠状动脉造影评估的移植物闭塞，次要结局是主要不良心脏或脑血管事件。采用混合效应多变量Cox回归模型评估移植物管道类型和定量血流比率对移植物闭塞的独立影响。
共纳入1314例患者，其中有292条桡动脉靶血管和1736条大隐静脉移植物靶血管。中位随访时间为3年。定量血流比率值0.57被确定为最佳阈值。与大隐静脉移植物相比，在定量血流比率大于0.57的靶血管中，桡动脉的通畅率较低（调整后的风险比，4.63，95%置信区间，2.61-8.21，P<0.001），但在定量血流比率为0.57或更低的血管中，桡动脉的通畅率较高（调整后的风险比，0.14，95%置信区间，0.03-0.68，P=0.015）。
桡动脉移植物在定量血流比率值较低的靶血管中可能具有更高的通畅率，而大隐静脉移植物在定量血流比率值较高的血管中可能具有更高的短期通畅率。
