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).
Meta-Analysis (n=149,902)
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?
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.
Estimación del efecto: 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))
Background There remains uncertainty regarding the second-best conduit after the internal thoracic artery in coronary artery bypass grafting. Few studies directly compared the clinical results of the radial artery ( RA ), right internal thoracic artery ( RITA ), and saphenous vein ( SV ). No network meta-analysis has compared these 3 strategies. Methods and Results MEDLINE and EMBASE were searched for adjusted observational studies and randomized controlled trials comparing the RA , SV , and/or RITA as the second conduit for coronary artery bypass grafting. The primary end point was all-cause long-term mortality. Secondary end points were operative mortality, perioperative stroke, perioperative myocardial infarction, and deep sternal wound infection ( DSWI ). Pairwise and network meta-analyses were performed. A total of 149 902 patients (4 randomized, 31 observational studies) were included ( RA , 16 201, SV , 112 018, RITA, 21 683). At NMA , the use of SV was associated with higher long-term mortality compared with the RA (incidence rate ratio, 1.23; 95% CI , 1.12-1.34) and RITA (incidence rate ratio, 1.26; 95% CI , 1.17-1.35). The risk of DSWI for SV was similar to RA but lower than RITA (odds ratio, 0.71; 95% CI , 0.55-0.91). There were no differences for any outcome between RITA and RA , although DSWI trended higher with RITA (odds ratio, 1.39; 95% CI , 0.92-2.1). The risk of DSWI in bilateral internal thoracic artery studies was higher when the skeletonization technique was not used. Conclusions The use of the RA or the RITA is associated with a similar and statistically significant long-term clinical benefit compared with the SV . There are no differences in operative risk or complications between the 2 arterial conduits, but DSWI remains a concern with bilateral ITA when skeletonization is not used.
Gaudino et al. (Sat,) 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).
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