Radial Artery Patency and Clinical Outcomes Study–Saphenous Vein - RAPCO-SV

Nov 06, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Heart Foundation (Australia)
Date Presented:
11/06/2022
Date Published:
11/06/2022
Original Posted Date:
11/06/2022
References

Contribution To Literature:

The RAPCO-SV trial showed that a radial artery bypass graft improves adverse cardiovascular outcomes compared with a saphenous vein bypass graft.

Description:

The goal of the trial was to evaluate a radial artery bypass graft compared with a saphenous vein bypass graft among patients undergoing coronary artery bypass graft (CABG) surgery.

Study Design

  • Randomized
  • Parallel

Patients undergoing CABG were randomized to a radial artery bypass graft (n = 113) versus a saphenous vein bypass graft (n = 112). The left internal thoracic artery to the left anterior descending artery was considered standard of care for all participants. Randomization was applied to the second bypass graft.

  • Total number of enrollees: 225
  • Duration of follow-up: 16.5 years
  • Mean patient age: 73 years
  • Percentage female: 19%
  • Percentage with diabetes: 46%

Inclusion criteria:

  • Patients ≥70 years or ≥60 years with diabetes undergoing CABG with ≥2 bypass grafts

Exclusion criteria:

  • Small radial artery or poor flow in the ulnar artery
  • Left ventricular ejection fraction <35%
  • Advanced chronic kidney disease
  • FEV1 <1 L
  • Body mass index >35 kg/m2

Other salient features/characteristics:

  • Mean number of grafts, 3.3

Principal Findings:

The primary outcome, all-cause mortality, myocardial infarction, or repeat revascularization, occurred in 60.2% of the radial artery bypass group vs. 73.2% of the saphenous vein bypass group (p = 0.04).

Secondary outcomes:

  • Mortality: 52.2% of the radial artery group vs. 63.4% of the saphenous vein bypass group (p = 0.08)
  • Repeat revascularization: 10.6% of the radial artery group vs. 16.1% of the saphenous vein bypass group (p = 0.13)

Interpretation:

Among patients undergoing CABG, the radial artery bypass graft was associated with improved outcomes compared with a saphenous vein bypass graft. There were numerically fewer deaths in the radial artery bypass graft group. Further research is needed to determine if an instrumented radial artery can serve as a satisfactory bypass conduit.

References:

Presented by Dr. David L. Hare at the American Heart Association Scientific Sessions, Chicago, IL, November 6, 2022.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and SIHD

Keywords: AHA Annual Scientific Sessions, AHA22, Angina Pectoris, Cardiac Surgical Procedures, Coronary Artery Bypass, Diabetes Mellitus, Geriatrics, Mammary Arteries, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Radial Artery, Saphenous Vein, Standard of Care


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