Key result
A pharmacological protocol using dihydropyridine calcium channel blockers reduced major adverse cardiac and cerebrovascular events to 9.3% compared to 15.7% in the control group at 5 years.
Why the study?
The study evaluated the effect of a pharmacological protocol for radial artery spasm prevention, using systemic and local dihydropyridine calcium channel blockers, on long-term outcomes after autoarterial CABG.
Does a pharmacological protocol using dihydropyridine calcium channel blockers reduce major adverse cardiac and cerebrovascular events in patients undergoing autoarterial coronary artery bypass grafting with a radial artery graft?
Cohort (n=455)
No
Does a pharmacological protocol using dihydropyridine calcium channel blockers reduce major adverse cardiac and cerebrovascular events in patients undergoing autoarterial coronary artery bypass grafting with a radial artery graft?
A pharmacological protocol using systemic and local dihydropyridine calcium channel blockers significantly reduces long-term major adverse cardiovascular events, primarily myocardial infarction and repeat revascularization, in patients undergoing CABG with radial artery grafts.
May be hypothesis-generating for dihydropyridine CCB use in radial artery CABG; should not yet change practice without randomized evidence.
Aim. To assess the effect of a pharmacological protocol for the prevention of radial artery spasm, which is based on the systemic and local use of dihydropyridine calcium channel blockers, on the long-term outcomes of autoarterial coronary artery bypass grafting. Material and methods . According to the protocol, oral nifedipine at a dose of 5 mg/day is prescribed 3 days before surgery. Then, after the radial artery is isolated, the vessel is preserved in a solution of nifedipine (adalat) until it is used. After releasing the clamp from the aorta, a nifedipine (adalat) is infused intravenously at a dose of 0,63 mg/h. In the postoperative period, the infusion of nifedipine continues for 6 hours. In the future, patients are recommended to take dihydropyridine calcium channel blockers at a dose of 5 mg/day after discharge from the hospital. Results. The use of the pharmacological protocol (n=225) is associated with a lower number of major cardiovascular events (mortality, myocardial infarction, stroke) compared with the control group (n=230) (9,3% and 15,7%, p=0,031) during the 5-year follow-up. This result was achieved mainly by reducing the incidence of myocardial infarction (6,2% and 12,6%, p=0,018). Also, the use of the pharmacological protocol led to a decrease in repeated revascularizations (4,4% and 16,1%, p=0,0001) compared with the control group. Conclusion. The use of a pharmacological protocol for the prevention of radial artery spasm based on the systemic use of dihydropyridine calcium channel blockers improves the long-term outcomes of autoarterial coronary artery bypass grafting.
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Затолокин et al. (2022) conducted a cohort in Coronary artery disease (n=455). Pharmacological protocol for radial artery spasm prevention (nifedipine/adalat) vs. No pharmacological protocol for spasm prevention (historical control) was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (p=0.031). A pharmacological protocol using dihydropyridine calcium channel blockers reduced major adverse cardiac and cerebrovascular events to 9.3% compared to 15.7% in the control group at 5 years.
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