• John Lin, Wen Cheng, Lawrence S Czer, Michele A De Robertis, James Mirocha, Andrea Ruzza, Robert M Kass, Ali Khoynezhad, Danny Ramzy, Fardad Esmailian, and Alfredo Trento.
• Division of Cardiothoracic Surgery, Cedars Sinai Heart Institute, Los Angeles, CA.
• J Am Heart Assoc. 2013 Aug 22; 2 (4): e000266.

BackgroundThe clinical benefits of the left internal thoracic artery-to-left anterior descending coronary artery graft are well established in coronary artery bypass graft surgery (CABG). However, limited data are available regarding the long-term outcome of the radial artery (RA) as a secondary conduit over the established standard of the saphenous venous graft.Methods And ResultsWe compared the 12-year survival outcome in a set of propensity-matched CABG patients who received either the RA or the saphenous vein as a secondary conduit. A multivariable logistic regression that included 18 baseline characteristics was used to define the propensity of receiving an RA graft. The propensity model resulted in 260 matched pairs who underwent first-time isolated CABG from 1996 to 2001 with similar preoperative characteristics (C statistic=0.86). The cumulative 12-year survival estimated by use of the Kaplan-Meier method was higher for the RA graft patients (hazard ratio 0.76; P=0.03). This survival advantage was especially significant in diabetics (P=0.005), in women (P=0.02), and in the elderly (P=0.04.) The protective effect appeared beginning at year 5 post surgical intervention.ConclusionThe RA as a secondary conduit provided superior long-term survival after CABG, especially in diabetic patients, women, and the elderly. This effect was most pronounced >5 years after surgery.

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