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  1. Iqbal Malik, Editor

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    ISCHAEMIC HEART DISEASE

    The radial artery as graft conduit: a good vessel at 1 year, a better one at 5? ▸

    In the past decade, the radial artery has frequently been used for coronary bypass surgery, despite concern regarding the possibility of graft spasm. The investigators enrolled 561 patients at 13 centres. The left internal thoracic artery was used to bypass the anterior circulation. The radial artery graft was randomly assigned to bypass the major vessel in either the inferior (right coronary) territory or the lateral (circumflex) territory, with the saphenous vein graft used for the opposing territory (control). The primary end point was graft occlusion, determined by angiography 8–12 months postoperatively. Angiography was performed at one year in 440 patients: 8.2% of radial artery grafts and 13.6% of saphenous vein grafts were completely occluded (p  =  0.009). Diffuse narrowing of the graft (the angiographic “string sign”) was present in 7.0% of radial artery grafts and only 0.9% of saphenous vein grafts (p  =  0.001). The absence of severe native vessel stenosis increased risk of occlusion of the radial artery graft and diffuse narrowing of the graft. Thus the combined rate of occlusion or string sign was not significantly different for vein versus radial artery. However, the string sign in a radial graft is often not associated with ischaemia, and can improve over time. Long term, the difference in occlusion rates might increase as saphenous vein grafts are known to continue to degenerate. The longer term follow up of these groups of patients will be of great interest.

    ▴ Desai ND, Cohen EA, Naylor DC, et al, for the Radial Artery Patency Study Investigators. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Eng J Med2004;351:2302–9.
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    HEART FAILURE

    Ablate AF in heart failure? ▸

    Congestive heart failure and atrial fibrillation (AF) often coexist, and each adversely affects the other with respect to management and prognosis. Fifty eight consecutive patients with congestive heart failure and a left ventricular ejection fraction < 45% who were undergoing catheter ablation for AF were matched to 58 patients without congestive heart failure who were undergoing ablation for AF. Patients’ left ventricular function …

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