Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival

Abstract Objective Whether radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival than saphenous vein (SV) remains undetermined. Methods Study population included a selected low-risk group of 275 subjects undergoing BITA grafting with RA as third arterial conduit (BITA+RA) and 489 undergoing BITA grafting with additional SV graft (BITA+SV). RA was considered only for target stenosis of at least 75%. We finally obtained 275 propensity score–matched pairs for comparison. Results Operative mortalities were 1 (0.3%) and 2 (0.7%) for BITA+RA and BITA+SV, respectively ( P = .56). After mean follow-up of 10.6 ± 4.8 years, BITA+RA survivals were 97.4% ± 0.9%, 90.3% ± 2.0%, and 81.7% ± 3.2% at 5, 10, and 15 years, respectively, versus 97.0% ± 1.0%, 94.1% ± 1.5%, and 82.1% ± 3.4% (log-rank P = .54; hazard ratio, 1.16; 95% confidence interval, 0.71-1.9). Strategies showed comparable survivals when RA or SV was used to graft the right ( P = .79) or left ( P = .55) coronary system only. Lack of survival advantage for BITA+RA was confirmed in patients 60 years and younger ( P = .80) and older than 60 years ( P = .53), with and without diabetes mellitus ( P = .89 and P = .54, respectively), and with or without left ventricular dysfunction ( P = .95 and P = .65, respectively). Conclusions Long-term survival in selected low-risk patients undergoing BITA grafting was not extended by using RA as third arterial conduit in preference to SV.