Radial Artery Versus Right Internal Thoracic Artery Versus Saphenous Vein as the Second Conduit for Coronary Artery Bypass Surgery: A Network Meta‐Analysis of Clinical Outcomes
Key result
Using the radial artery or right internal thoracic artery as a second conduit for CABG was associated with lower long-term mortality compared with the saphenous vein (IRR 1.23 and 1.26, respectively).
Why the study?
Uncertainty remains regarding the second-best conduit after the internal thoracic artery in CABG, with few direct comparisons and no network meta-analysis of the three strategies.
Does the use of the radial artery or right internal thoracic artery compared to the saphenous vein as a second conduit improve long-term mortality in patients undergoing coronary artery bypass grafting?
Comparison
RA vs RITA vs SV as the second conduit
Design
Pairwise and network meta-analysis of 4 randomized and 31 observational studies
Authors
Discussion
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Implication
Supports radial or right internal thoracic artery over saphenous vein as second conduit in CABG; confirms long-term mortality benefit in network meta-analysis.
Study Design
Type
Meta-Analysis (n=149,902)
Structured PICO
Does the use of the radial artery or right internal thoracic artery compared to the saphenous vein as a second conduit improve long-term mortality in patients undergoing coronary artery bypass grafting?
P
Population
149,902 patients undergoing coronary artery bypass grafting (pooled from 4 randomized controlled trials and 31 observational studies)
I
Intervention
Radial artery (RA) or right internal thoracic artery (RITA) as the second conduit
C
Comparator
Saphenous vein (SV) as the second conduit
O
Outcome
All-cause long-term mortalityhard clinical
Main Result
Effect estimate: IRR 1.23 (SV vs RA); IRR 1.26 (SV vs RITA) (95% CI 1.12-1.34 (SV vs RA); 1.17-1.35 (SV vs RITA))
Using the radial artery or right internal thoracic artery as a second conduit in CABG provides a significant long-term survival benefit over the saphenous vein, though RITA may increase deep sternal wound infection risk if skeletonization is not used.
Cite This Study
Gaudino et al. (2019) conducted a meta-analysis in Coronary artery bypass grafting (n=149,902). Radial artery (RA) or right internal thoracic artery (RITA) vs. Saphenous vein (SV) was evaluated on All-cause long-term mortality (IRR 1.23 (SV vs RA); IRR 1.26 (SV vs RITA), 95% CI 1.12-1.34 (SV vs RA); 1.17-1.35 (SV vs RITA)). Using the radial artery or right internal thoracic artery as a second conduit for CABG was associated with lower long-term mortality compared with the saphenous vein (IRR 1.23 and 1.26, respectively).