Long-Term Angiographic Patency of Coronary Artery Bypass Grafts: A Systematic Review and Network Meta-Analysis

Objective: We investigated the angiographic patency rates of all conduits used in coronary artery bypass grafting (CABG) by performing a network meta-analysis of the current available randomized evidence.

Methods: A systematic literature search was conducted for randomized controlled trials comparing angiographic patency rates of conventionally-harvested saphenous vein (CON-SV), no-touch saphenous vein (NT-SV), radial artery (RA), right internal thoracic artery (RITA), or the gastroepiploic artery (GEA) as the second conduit in CABG. The primary outcome was graft patency rate. The secondary outcome was perfect graft patency.

Results: Fourteen trials were included with 3,651 grafts analyzed via protocol-driven angiography. The weighted mean follow-up was 4.28 years. Compared to the CON-SV, both the RA (incidence rate ratio [IRR] 1.09, 95% confidence interval [CI] 1.04-1.14) and the NT-SV (IRR 1.09, 95% CI 1.03-1.16) were associated with significantly higher graft patency rate. The RA ranked as the best conduit (rank score for RA 0.84 vs 0.75 for NT-SV, 0.56 for RITA, 0.19 for CON-SV, and 0.16 for GEA) in terms of graft patency.

Conclusions: Compared to the CON-SV, only the RA and NT-SV grafts are associated with higher patency rates. The RA ranks as the best conduit.