Importance Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials. Objective To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. Design, Setting, and Participants Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019. Interventions Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. Main Outcomes and Measures The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. Results A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). Conclusions and Relevance In this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.

中文翻译：

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在接受冠状动脉搭桥术的患者中，桡动脉移植物与大隐静脉移植物与长期心血管结局的关系

重要性观察性研究表明，与使用大隐静脉移植物相比，使用桡动脉移植物进行冠状动脉旁路移植术可能会改善临床结果，但这尚未在随机试验中得到证实。目的 比较长期随访后接受桡动脉与隐静脉移植进行冠状动脉旁路移植术的患者的临床结果。设计、设置和参与者 比较来自 5 个国家（澳大利亚、意大利、塞尔维亚、韩国和英国）接受孤立冠状动脉旁路移植术的成年患者的桡动脉与大隐静脉移植物的患者水平汇总分析，从 1997 年开始招募至 2009 年，并于 2019 年完成后续工作。干预 患者随机接受桡动脉（n = 534）或隐静脉（n = 502）移植以进行冠状动脉旁路移植术。主要结果和测量主要结果是死亡、心肌梗塞或再次血运重建的复合结果，次要结果是死亡或心肌梗塞的复合结果。结果 共有 1036 名患者被随机分组​​（平均年龄，桡动脉组 66.6 岁 vs 大隐静脉组 67.1 岁；桡动脉组 376 名 [70.4%] 男性 vs 隐静脉组 351 名 [69.9%] ); 942 名（90.9%）最初随机分组的患者完成了 10 年的随访（桡动脉组 510 名）。在 10 (10-11) 年的中位（四分位距）随访中，与大隐静脉相比，桡动脉的使用，在冠状动脉旁路移植术中，死亡、心肌梗死或再次血运重建的复合结局发生率在统计学上显着降低（总事件为 220 对 237 次；每 1000 患者年 41 对 47 次；风险比为 0.73 [ 95% CI，0.61-0.88]；P < .001）和死亡或心肌梗死的复合（188 对 193 总事件；每 1000 患者年 35 对 38 事件；风险比，0.77 [95% CI，0.63 -0.94]；P = .01）。结论和相关性 在这项中位随访 10 年的个体参与者数据荟萃分析中，在接受冠状动脉旁路移植术的患者中，与大隐静脉相比，桡动脉的使用与以下复合风险较低相关心血管结果。