Author + information
- Received October 23, 2018
- Revision received January 25, 2019
- Accepted February 7, 2019
- Published online May 6, 2019.
- Mario Gaudino, MDa,∗∗ (, )@WeillCornell,
- Umberto Benedetto, MDb,∗,
- Stephen E. Fremes, MDc,
- David L. Hare, MDd,e,
- Philip Hayward, MDd,
- Neil Moat, MDf,
- Marco Moscarelli, MDg,
- Antonino Di Franco, MDa,
- Giuseppe Nasso, MDg,
- Miodrag Peric, MDh,
- Ivana Petrovic, MDh,
- John D. Puskas, MDi,
- Giuseppe Speziale, MDg,
- Kyung Jong Yoo, MDj,
- Leonard N. Girardi, MDa,
- David P. Taggart, MDk,
- for the RADIAL Investigators†
- aDepartment of Cardiothoracic Surgery, Cornell Medicine, New York, New York
- bBristol Heart Institute, Bristol, United Kingdom
- cSchulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- dUniversity of Melbourne, Melbourne, Victoria, Australia
- eThe Austin Hospital, Melbourne, Victoria, Australia
- fRoyal Brompton & Harefield Trust, London, United Kingdom
- gAnthea Hospital, Bari, Italy
- hDedinje Cardiovascular Institute and Belgrade University School of Medicine, Belgrade, Serbia
- iIcahn School of Medicine at Mount Sinai, New York, New York
- jYonsei University College of Medicine, Seoul, Korea
- kUniversity of Oxford, Oxford, United Kingdom
- ↵∗Address for correspondence:
Dr. Mario Gaudino, Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, New York 10065.
Background Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery.
Objectives The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts.
Methods Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion.
Results The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio: 0.52; 95% confidence interval: 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio: 0.20; 95% confidence interval: 0.08 to 0.49; p < 0.001).
Conclusions In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.
↵∗ Drs. Gaudino and Benedetto contributed equally to this work.
The project was funded by the Department of Cardiothoracic Surgery of Weill Cornell Medicine. The funders had no role in any part the study. Dr. Benedetto was supported by The National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC). Dr. Fremes was supported in part by the Bernard S. Goldman Chair in Cardiovascular Surgery. Dr. Hare has served as part of the Advisory Board for Amgen, AstraZeneca, Merck, and Sanofi; has received lecture fess from Novartis; has received consulting fees from Pfizer; and has received research funds from Servier. Dr. Moat has served as CMO for Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This paper was presented at the 2018 American Heart Association Scientific Sessions, Chicago, Illinois. Danny Ramzy, MD, PhD, served as Guest Associate Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received October 23, 2018.
- Revision received January 25, 2019.
- Accepted February 7, 2019.
- 2019 American College of Cardiology Foundation
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