Left Internal Thoracic Artery Composite Grafting with the Right Internal Thoracic Versus Radial Artery in Coronary Artery Bypass Grafting

Abstract

The aim of this study was to compare the results of all arterial multivessel coronary artery bypass grafting using the left internal thoracic artery composite bypass graft constructed with the right internal thoracic artery or radial artery. Patients undergoing coronary artery bypass grafting with a left internal thoracic artery constructed as a composite bypass graft with either a right internal thoracic artery (n = 45; RITA group) or radial artery (n = 352; RA group) between 2003 and 2009 were included in the present study. The three-year patency rates for the RITA and RA groups were 91.8%± 4.3% and 78.6%± 3.4%, respectively (p = 0.12). Adjustments for covariates revealed the radial artery patency to be significantly inferior to the right internal thoracic artery graft (hazard ratio 4.35, 95% confidence interval 1.05 to 18.0; p = 0.043). Reintervention for target coronary artery occlusion was required in two patients in the RA group over a mean follow-up period of 35.5 ± 21.5 months. There were 43 deaths in the entire cohort of which 20 were cardiac. After adjustment for significant variables, the risk of all-cause mortality, cardiac death, and the composite of adverse events (death, reintervention, myocardial infarction, and stroke) were similar for the two groups (p = 0.98, 0.99, and 0.21, respectively). Although superior patency was observed with the right internal thoracic artery over the radial artery graft, a significant commensurate benefit in reducing the incidence of major adverse clinical outcomes was not necessarily shown.