Predictors of Radial Artery Use in Coronary Bypass Grafting: A Multi-institutional Cohort Study

Abstract

Introduction

To explore trends and analyze clinical and angiographic predictors of radial utilization in patients undergoing isolated coronary artery bypass grafting (CABG).

Methods

We analyzed data from 17,352 patients undergoing isolated CABG (January 1, 2017, to December 31, 2022) in a regional Society of Thoracic Surgeons Adult Cardiac Surgery Database linked with the National Cardiovascular Data Registry CathPCI registry. Multivariable logistic regression assessed predictors of radial artery (RA) use.

Results

Radial artery grafts (RAGs) were used in 1745 patients (10.0%). Utilization increased from 3.34% (2017) to 14.24% (2022) (P < 0.001). Patients receiving RAGs were younger (60 [53-67] versus 67 [60-73] y, P < 0.001), had lower predicted risk of morbidity or mortality (6% versus 9%, P < 0.001), and lower incidence of heart failure (25% versus 32%, P < 0.001). Predictors of RA use included higher preoperative ejection fraction (odds ratio [OR] 1.18 [1.10-1.27], P < 0.001), male sex (OR 1.72 [1.44-2.05], P < 0.001), and increasing surgery year (OR 1.38 [1.33-1.44], P < 0.001). Conversely, severe chronic kidney disease (OR 0.30 [0.18-0.49], P < 0.001), older age (OR 0.56 [0.52-0.60], P < 0.001), and higher predicted risk of morbidity or mortality (OR 0.79 [0.71-0.89], P < 0.001) decreased likelihood of receiving a RAG. Critical lesion stenosis (≥90%) did not predict RA use (OR 1.06 [0.78-1.44], P = 0.70).

Conclusions

RA use in CABG remains limited, predominantly in younger, healthier patients. These findings suggest surgeons likely consider clinical and potential long-term benefits in choosing radial grafting. Understanding relative predictors of radial grafting could enhance CABG outcomes across patient demographics.