CABG: does calcium-channel blocker use influence outcomes of radial artery grafts?

  • Gaudino M & al.
  • J Am Coll Cardiol
  • 14 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Calcium-channel blocker (CCB) therapy is associated with higher patency rate and lower risk for major adverse cardiac events (MACE, death, myocardial infarction and repeat revascularisation) at 5 years in patients undergoing coronary revascularisation using radial artery (RA) grafts.

Why this matters

  • Findings support the routine use of CCB after coronary artery bypass graft (CABG) surgery using the RA.

Study design

  • Patient-level pooled analysis of 6 randomised controlled trials evaluated the effect of CCB on mid-term clinical and angiographic outcomes of RA grafts used for CABG (n=732, 502 on CCB; median clinical follow-up: 60 months).
  • Primary outcome: composite of MACE; secondary outcome: RA graft occlusion.
  • Funding: supported by the National Institute for Health Research Bristol Biomedical Research Centre.

Key results

  • At month 36, 72 and 108, the cumulative incidence of MACE and RA occlusion in the CCB vs no CCB was:
    • MACE: 3.7% vs 9.3%; 13.4% vs 17.6% and 16.8% vs 20.5%, respectively (log-rank P=.003).
    • RA occlusion: 0.9% vs 8.6%; 9.6% vs. 21.4% and 14.3% vs 38.9%, respectively (log-rank P <.001>
  • After adjustment, CCB therapy was associated with a lower risk for:
    • MACE (multivariate Cox HR, 0.52; 95% CI, 0.31-0.89; P=.02)
    • RA graft occlusion (multivariate Cox HR, 0.20; 95% CI, 0.08-0.49; P<.001>

Limitations

  • Post hoc analysis.

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