The impact of the radial artery or the saphenous vein in addition to the bilateral internal mammary arteries on late survival: A propensity score analysis

Abstract

Background: Long-term survival benefits of full arterial revascularization with radial artery (RA) used in addition to bilateral internal mammary arteries (BIMA) compared with saphenous vein (SV) used in addition to BIMA has not been clearly defined.Methods: We retrospectively analyzed 660 3-vessel coronary artery disease subjects who received BIMA in addition to either RA (n ¼ 206) or SV (n ¼ 454) grafting in a period between June 1999 and November 2017. After propensity score matching, we obtained 190 matched pairs for analysis.

Total arterial revascularization strategies: A meta‐analysis of propensity score‐matched observational studies

“…On one hand, several retrospective studies and one meta‐analysis, have reported benefits, in terms of long‐term survival of adding a third arterial graft to a BIMA strategy. On the other hand, among the three studies included in the present meta‐analysis and exploring the same issue, only the last one reported that adding a third arterial graft, in this case, the radial artery, provides a long‐term survival benefit. Also, a recent meta‐analysis failed to show a benefit of adding an arterial graft over a venous graft to BIMA for the right coronary artery …”

“…Studies were excluded for the following reasons: no comparison between TAR and non‐TAR strategy (n = 32), sample population derived from a previously published and included series (n = 1), and lack of propensity score matching (n = 1). Consequently, 18 articles were included in our study . Mean age and mean body mass index of the included populations were 65.6 years (±7.6) and 27.1 (±1.7).…”

“…Of these studies, 10 described a BIMA usage of ≥80%. For this reason, they were assigned to the category “TAR with BIMA” . The remaining 4 studies were categorized as “TAR without BIMA” (Figure ).…”

“…Six studies of the non‐TAR group received a second artery conduit, besides LIMA, (Buxton 2012, RIMA = 11%; Formica, RIMA = 100%; Mohammadi, RIMA = 100%; Navia, radial artery = 75%; Shi, RIMA = 100%; Suzuki, RIMA = 30%; and gastroepiploic artery = 14%). Of these, three proposed a comparison between BIMA plus radial artery (TAR group) versus BIMA plus saphenous graft (non‐TAR group): Formica, Mohammadi, and Shi …”

“…These studies were assigned to the group “two arteries in TAR”. The remaining nine studies showed ≥2.50 arterial conduits and therefore, they were assigned to the “three arteries in TAR” group. The number of arterial conduits per patient in these nine studies were: Bisleri 2017 = 2.52, Buxton 2012 = 3.03, Buxton 2014 = 2.81, Formica = 3.00, Garatti = 3.20, Mohammadi = 3.00, Nasso = 3.10, Shi = 3.12, and Suzuki = 3.45 …”