Radial Artery Patency and Clinical Outcomes Study (RAPCO): A 15-Year Follow-Up Study | SCAI

Why is this study important?

  • Conflicting data regarding durability of the free radial artery (RA) graft as a non-left internal thoracic artery (LITA/LIMA) conduit in CABG procedures 
  • Long-term (>15 year) follow-up 
  • Two randomized trials in one study: RAPCO-RITA – RA vs. FRITA (free right internal thoracic artery) and RAPCO-SV – RA vs. SVG (saphenous vein graft) 

What question was this study supposed to answer?

Is a free RA graft a durable conduit for CABG?

What did the study show?

  • In the RAPCO-RITA study, randomization was 196 in RA arm and 198 in the RITA arm. > 88 % were men and 11 % were diabetics in both groups
  • The left circumflex was grafted in approximately 2/3rd of cases and the right coronary in approximately 1/3rd of cases 
  • RA graft had a better outcome than RITA with Absolute 9% and Relative 26% risk reduction in MACE (P=0.04) and an Absolute 8% and Relative 31% reduction in mortality (P=0.06) 
  • In the RAPCO-SVG study, randomization was 113 in the RA arm and 112 in the SVG arm. > 81 % were men and 45 % were diabetics 
  • The Left circumflex was grafted in approximately 2/3rd of cases and the right coronary in approximately 1/3rd of cases   
  • There was Absolute 13% and Relative 29% risk reduction in MACE (P=0.04) and Absolute 13% and Relative 29% reduction in mortality (P=0.08)  
  • Both studies did not address Instrumented radial arteries as satisfactory CABG conduits 

Conclusions

  • Long-term (> 15 year) results of two integrated trials demonstrating better clinical outcomes using RA grafting compared with both RITA and SV 
  • Currently < 10 of CABG procedures use RA graft. This study supports the use of RA graft as an arterial conduit in CABG
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