http:www.cardiovascularbusiness.com http:www.healthimaging.com http:www.clinical-innovation.com

1. Steve Goldman, M.D.
ClinicalTrials.gov number, NCT00054847

2. A Randomized Trial Radial Artery
Graft vs. Saphenous Vein Grafts
In CABG
Tucson VA
Hospital

3. I have no financial conflict of interest for
this study.

4.  Arterial grafts - better conduits than veins – LIMA
 Other arterial grafts
 Right internal/free internal mammary, gastroepiploic,
splenic
 Radial artery - easiest to harvest, most popular
 2008 - STS data base
 163,048 CABG
 10,319 radial artery grafts
 Problem - patency radial artery grafts not clear

5.  Prospective randomized trial
 One year angiographic patency Radial Artery (RA)
vs Saphenous Vein (SV)
 11 VA medical centers (2003-2008)
 733 patients randomized
 RA – 366
 SV - 367
 Study graft either RA or SV

6. Albuquerque Hines New Orleans
Ann Arbor Houston Richmond
Birmingham Little Rock Tucson
West Roxbury Minneapolis

7.  Radial artery better patency
 Proposed-one-year rates
 92% RA
 83% SV
Goldman et al, 1988-1994 CSP’s 207/297/364, 2004

8.  90% power with a two-sided type I error of 5%
 Expected one-year catheterization completion
rate of 65%
 Final enrollment
 733 patients, originally planned 874
 One-year catheterization completion rate (73%)
 Higher than expected
 Post hoc power 89% to detect 92% RA vs 83% SV

10.  Selective graft patency (RA vs SV)
 LAD: 83% vs 88%
 CX: 93% vs 89%
 RCA: 86% vs 88%
 No differences

11.  Disease in grafts
 More high grade disease (string sign)
 RA - 8% vs SV - 1%, (P<0.001)
 Endoscopic harvesting
 SV - lower patency 78% vs 91%, (P=0.009)
 N = 72
 RA - no difference 100% vs 89%
 N = 18

12. 7.6%
SYNTAX
Serruys et al.,
NEJM 360:961-972
2009

13.  On pump vs off pump
 RA - no difference patency (89% vs 89%)
 SV - higher patency on pump (90% vs 78%)
 Off pump numbers small RA n=41 vs SV n=48
 Quality of life
 No difference at 3 months or 12 months

15. The other prospective randomized study RAPS
(Desai et.al NEJM 2004).
CSP-474 RAPS
 Randomized RA or SV  Both RA and SV as
study grafts
 Surgeon chose
recipient vessel  Randomized to
recipient vessel

16. CSP-474 RAPS
 One year patency no  One year patency, RA
difference better
 RA – 89% vs SV – 89%
 RA - 92% vs SV - 86%
 Best recipient vessel was
 Fewer patients
study vessel required
 Cannot separate
 We can define:
complications
 Patient characteristics
 Isolate complications
 One week cath/monitor
disease progression

17.  No difference in radial artery graft vs
saphenous vein graft at one year
 Our study group funded by VA Cooperative
Studies Program for five year angiographic
follow up

18.  Gulshan Sethi, M.D.,  Edward McFalls M.D.
 William Holman, M.D.
 Herb Ward, M.D.
 Rose Kelly, M.D.
 Kelvin Lee, Ph.D.
 Birger Rhenman, M.D.
 Stephen Fremes, M.D.  Gareth Tobler, M.D.
 Hoang Thai, M.D.  Faisal G. Bakaeen, M.D.
 Todd Wagner Ph.D.  Mohammed Moursi, M.D.
 Yajie Wang, M.S.  Michael Crittenden, M.D.
 Vigneshwar Kasirajan, M.D.
 Lori Planting, B.A.
 Claire Duvernoy, M.D.
 Meredith Miller, M.A.  Stewart Pett, M.D.
 Yvette Rodriguez, R.N.  Michelle Ratliff, M.D.
 Elizabeth Juneman, M.D.  Anand Irimpen, M.D.
 Douglas Morrison, M.D.  William Gunnar, M.D.
 Mary Kaye Pierce, N.P.
 Donald Thomas, M.D.
 Thomas Moritz, M.S.
 Sandra Kreamer R.N.
 Domenic Reda, Ph.D.
 Mei-Chiung Shih, Ph.D.  Lynn Harrison, M.D.