Steve Goldman, M.D.
ClinicalTrials.gov number, NCT00054847
A Randomized Trial Radial Artery
Graft vs. Saphenous Vein Grafts
In CABG
Tucson VA
Hospital
I have no financial conflict of interest for
this study.
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Arterial grafts - better conduits than veins – LIMA
Other arterial grafts
 Right internal/free internal mammary, gastroepiploic,
splenic
 Radial artery - easiest to harvest, most popular
2008 - STS data base
 163,048 CABG
 10,319 radial artery grafts
Problem - patency radial artery grafts not clear
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Prospective randomized trial
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One year angiographic patency Radial Artery (RA)
vs Saphenous Vein (SV)
11 VA medical centers (2003-2008)
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733 patients randomized
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RA – 366
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SV - 367
Study graft either RA or SV
Albuquerque
Ann Arbor
Birmingham
West Roxbury
Hines
Houston
Little Rock
Minneapolis
New Orleans
Richmond
Tucson
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Radial artery better patency
Proposed-one-year rates
 92% RA
 83% SV
Goldman et al, 1988-1994
CSP’s 207/297/364, 2004
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90% power with a two-sided type I error of 5%
 Expected one-year catheterization completion
rate of 65%
Final enrollment
 733 patients, originally planned 874
One-year catheterization completion rate (73%)
 Higher than expected
 Post hoc power 89% to detect 92% RA vs 83% SV
100
98
99%
97%
96
Radial Artery
94
92
89%
90
89%
88
86
84
One-week Patency
One-year Patency
Saphenous
Vein
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Selective graft patency (RA vs SV)
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LAD: 83% vs 88%
CX: 93% vs 89%
RCA: 86% vs 88%
No differences
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Disease in grafts
More high grade disease (string sign)
 RA - 8% vs SV - 1%, (P<0.001)
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Endoscopic harvesting
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SV - lower patency 78% vs 91%, (P=0.009)
 N = 72
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RA - no difference 100% vs 89%
 N = 18
8.0%
7.6%
7.0%
SYNTAX
Serruys et al.,
6.0%
NEJM 360:961-972
2009
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
1.0%
MI
2.0%
2.0%
0.7%
Stroke
Death
Operative
Mortality
CSP 474
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On pump vs off pump
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RA - no difference patency (89% vs 89%)
SV - higher patency on pump (90% vs 78%)
Off pump numbers small RA n=41 vs SV n=48
Quality of life

No difference at 3 months or 12 months
$60,000
$50,000
$40,000
$30,000
$43,476
$42,197
Total Cost
Surgical Cost
$20,000
P<0.01
$10,000
$13,629
$12,484
$0
Radial Artery
Saphenous Vein
The other prospective randomized study RAPS
(Desai et.al NEJM 2004).
CSP-474
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RAPS
Randomized RA or SV
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Surgeon chose
recipient vessel
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Both RA and SV as
study grafts
Randomized to
recipient vessel
CSP-474
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One year patency no
difference
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RAPS
 One year patency, RA
better
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RA – 89% vs SV – 89%
Best recipient vessel
was study vessel
We can define:

Patient characteristics

Isolate complications
One week cath/monitor
disease progression
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RA - 92% vs SV - 86%
Fewer patients
required
Cannot separate
complications
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No difference in radial artery graft vs
saphenous vein graft at one year
Our study group funded by VA Cooperative
Studies Program for five year angiographic
follow up
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Gulshan Sethi, M.D.,
William Holman, M.D.
Kelvin Lee, Ph.D.
Stephen Fremes, M.D.
Hoang Thai, M.D.
Todd Wagner Ph.D.
Yajie Wang, M.S.
Lori Planting, B.A.
Meredith Miller, M.A.
Yvette Rodriguez, R.N.
Elizabeth Juneman, M.D.
Douglas Morrison, M.D.
Mary Kaye Pierce, N.P.
Sandra Kreamer R.N.
Mei-Chiung Shih, Ph.D.
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Edward McFalls M.D.
Herb Ward, M.D.
Rose Kelly, M.D.
Birger Rhenman, M.D.
Gareth Tobler, M.D.
Faisal G. Bakaeen, M.D.
Mohammed Moursi, M.D.
Michael Crittenden, M.D.
Vigneshwar Kasirajan, M.D.
Claire Duvernoy, M.D.
Stewart Pett, M.D.
Michelle Ratliff, M.D.
Anand Irimpen, M.D.
William Gunnar, M.D.
Donald Thomas, M.D.
Thomas Moritz, M.S.
Domenic Reda, Ph.D.
Lynn Harrison, M.D.