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J Thorac Cardiovasc Surg 2003;125:1363-1371
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Radial artery patency and clinical outcomes: Five-year interim results of a randomized trial

From the Department of Cardiac Surgery,^a Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia, The Statistical Consulting Centre,^b University of Melbourne, Parkville, Victoria, Australia, and the Departments of Cardiology^c and Intensive Care and Research,^d Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia.

Supported by a grant from Ethicon, a division of Johnson & Johnson Medical. Also supported by the Sir Edward Dunlop Medical Research Foundation.

Received for publication April 17, 2002. Revisions requested June 18, 2002; revisions received Aug 5, 2002. Accepted for publication Aug 15, 2002. Address for correspondence: Brian F. Buxton, MD, Director of Cardiac Surgery, HS-5, Austin Hospital, Heidelberg, Victoria 3084, Australia. (E-mail: brian.buxton{at}austin.org.au).

Objective: This study was undertaken to compare elective angiographic patency and cardiac event-free survival of the radial artery graft with that of the free right internal thoracic artery or saphenous vein during a 10-year period after primary coronary artery bypass surgery.
Methods: This prospective, randomized, single-center trial was conducted on two groups of patients undergoing primary coronary artery bypass surgery. In a younger group (group 1, n = 285, <70 years), the radial artery was compared with the free right internal thoracic artery. In an older group (group 2, n = 153, ≥70 years), the radial artery was compared with the saphenous vein. The trial conduit was grafted to the largest available coronary artery other than the left anterior descending coronary artery. Angiography was scheduled at intervals between 0 and 10 years according to a second random assignment. Patients were followed up at yearly intervals to assess clinical outcomes. Clinical outcomes were analyzed on an intent-to-treat basis during the 10-year follow-up with time-related analyses. This interim study reports angiographic and clinical outcome results during the first 5 years.
Results: Graft patency estimates were as follows: 0.95 (95% confidence interval 0.85-0.99) in 39 radial arteries versus 1.0 in 29 right internal thoracic arteries (P = .4) in group 1, and 0.86 (95% confidence interval 0.67-0.99) in 24 radial arteries versus 0.95 (95% confidence interval 0.83-0.99) in 22 saphenous veins (P = .5) in group 2. Cardiac event-free survival estimates were as follows: 0.91 (95% confidence interval 0.76-0.99) for the radial artery versus 0.82 (95% confidence interval 0.63-0.99) for the right internal thoracic artery (P = .7) in group 1, and 0.84 (95% confidence interval 0.64-0.99) for the radial artery versus 0.89 (95% confidence interval 0.72-0.99) for the saphenous vein (P = .9) in group 2.
Conclusion: The 5-year interim results do not support the hypothesis that the radial artery has superior patency to or is associated with fewer clinical events than free right internal thoracic artery or saphenous vein grafts.