James Tatoulis

Objectives: Studies suggest that the radial artery (RA) exhibits superior patency compared to the saphenous vein (SV). We investigated whether older patients undergoing coronary artery bypass grafting (CABG) derive any survival benefit from the use of RAs. Methods: From 1995 to 2010, 6059 patients with triple vessel coronary disease underwent primary isolated CABG at 8 centres. From this, a study cohort of 4006 patients was formed with 3220 (80%) receiving at least 1 RA to supplement a single in-situ internal thoracic artery (ITA) (RA group) while 786 (20%) received only saphenous veins to supplement a single ITA (SV group). Propensity-score matching was used for risk adjustment. A separate analysis was performed for the 2149 patients (1645 RA, 504 SV) who were 70 years or older. Results: RA patients experienced reduced unadjusted 30-day mortality (1.4% vs 3.2%, P = 0.004) and superior unadjusted 15-year survival (51 ± 1.1% vs 35 ± 1.9%, P < 0.001). After propensity-score matching of 507 patient pairs, there was comparable 30-day mortality between groups (RA: 1.8% vs SV: 2.8%, P = 0.41). However, at 15 years, the RA group showed superior survival (42 ± 2.6% vs 35 ± 2.5%, P = 0.008). Amongst those ≥70 years (327 matched pairs), despite similar 30-day mortality (RA: 1.8% vs SV: 3.1%, P = 0.42), RA patients again exhibited improved survival (35 ± 3.3% vs 22 ± 2.8%, P = 0.004) at 15 years (Fig. 1). Conclusion: The addition of a radial artery is associated with a survival benefit even in older patients undergoing CABG. We postulate that this is secondary to its improved patency and other biological effects unique to arteries.