BACKGROUND: In the past decade, the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. ...BACKGROUND: In the past decade, the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a randomized trial in which we controlled for bias in the selection of patients and vessels. METHODS: We enrolled 561 pa tients at 13 centers. The left internal thoracic artery was used to bypass the anterior circulation. The radial-artery graft was randomly assigned to bypass the major vessel in either the inferior(right coronary)territory or the lateral(circumflex) territory, with the saphenous-vein graft used for the opposing territory(control). The primary end point was graft occlusion, determined by angiography 8 to 12 months postoperatively. RESULTS: Angiography was performed at one year in 440 patients: 8.2 percent of radial-artery grafts and 13.6 percent of saphenous-vein grafts were completely occluded(P=0.009). Diffuse narrowing of the graft(the angiographic “string sign”)was present in 7.0 percent of radial-artery grafts and only 0.9 percent of saphenous-vein grafts(P=0.001). The absence of severe native-vessel stenosis was associated with an increased risk of occlusion of the radial-artery graft and diffuse narrowing of the graft. Harvesting of the radial artery was well tolerated. CONCLUSIONS: Radialartery grafts are associated with a lower rate of graft occlusion at one year than are saphenous-vein grafts. Because the patency of radial-artery grafts depends on the severity of native-vessel stenosis, such grafts should preferentially be used for target vessels with highgrade lesions.展开更多
Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a populati...Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results -A population-based cohort study(n=68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission(angina, heart failure, myocardial infarction), repeat revascularization(angioplasty or CABG), and stroke readmission between men and women. Women were older(65±17 versus 62±13 years), more likely to present with urgent or emergent status(64%versus 56%), and less likely to receive arterial grafts(70%versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery(hazard ratio[HR] of 1.5, 95%confidence interval[CI] 1.36 to 1.56), and this increased risk persisted after 1 year(HR 1.2, 95%CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina(HR 1.3, 95%CI 1.24 to 1.38) and congestive heart failure(HR 1.1, 95%CI 1.06 to 1.21). Propensity-matched women had similar rates of death(HR 0.9, 95%CI 0.83 to 0.98) and repeat revascularization(HR 1.0, 95%CI 0.91 to 1.06). Conclusions -Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.展开更多
文摘BACKGROUND: In the past decade, the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm. Graft patency is a key predictor of long-term survival. We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a randomized trial in which we controlled for bias in the selection of patients and vessels. METHODS: We enrolled 561 pa tients at 13 centers. The left internal thoracic artery was used to bypass the anterior circulation. The radial-artery graft was randomly assigned to bypass the major vessel in either the inferior(right coronary)territory or the lateral(circumflex) territory, with the saphenous-vein graft used for the opposing territory(control). The primary end point was graft occlusion, determined by angiography 8 to 12 months postoperatively. RESULTS: Angiography was performed at one year in 440 patients: 8.2 percent of radial-artery grafts and 13.6 percent of saphenous-vein grafts were completely occluded(P=0.009). Diffuse narrowing of the graft(the angiographic “string sign”)was present in 7.0 percent of radial-artery grafts and only 0.9 percent of saphenous-vein grafts(P=0.001). The absence of severe native-vessel stenosis was associated with an increased risk of occlusion of the radial-artery graft and diffuse narrowing of the graft. Harvesting of the radial artery was well tolerated. CONCLUSIONS: Radialartery grafts are associated with a lower rate of graft occlusion at one year than are saphenous-vein grafts. Because the patency of radial-artery grafts depends on the severity of native-vessel stenosis, such grafts should preferentially be used for target vessels with highgrade lesions.
文摘Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results -A population-based cohort study(n=68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission(angina, heart failure, myocardial infarction), repeat revascularization(angioplasty or CABG), and stroke readmission between men and women. Women were older(65±17 versus 62±13 years), more likely to present with urgent or emergent status(64%versus 56%), and less likely to receive arterial grafts(70%versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery(hazard ratio[HR] of 1.5, 95%confidence interval[CI] 1.36 to 1.56), and this increased risk persisted after 1 year(HR 1.2, 95%CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina(HR 1.3, 95%CI 1.24 to 1.38) and congestive heart failure(HR 1.1, 95%CI 1.06 to 1.21). Propensity-matched women had similar rates of death(HR 0.9, 95%CI 0.83 to 0.98) and repeat revascularization(HR 1.0, 95%CI 0.91 to 1.06). Conclusions -Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.
