Are Radial-Artery Bypass Grafts Better Than Saphenous-Vein Grafts?

Although use of a left internal mammary-artery graft is standard for patients undergoing coronary-artery bypass grafting (CABG), most other bypass grafts use saphenous-vein conduits — at least in part because few high-quality data demonstrate clinical benefits of radial-artery grafts. A pooled analysis of data from five randomized trials (RADIAL; NEJM JW Cardiol Jul 2018 and N Engl J Med 2018; 378:2069) suggested that at 5-year follow-up, radial-artery grafts were associated with better clinical outcomes than saphenous-vein grafts. However, these benefits were driven almost entirely by differences in the rate of repeat revascularizations, without differences in survival or other “hard” clinical endpoints. To determine whether meaningful cli…