COMPARATIVE ANALYSIS OF LONG-TERM PATENCY AND MAJOR ADVERSE CARDIAC EVENTS IN LIMA, RADIAL ARTERY, AND SAPHENOUS VEIN GRAFTS IN CABG PATIENTS AT A TERTIARY CARE HOSPITAL IN PAKISTAN

Abstract

Objective: To compare long-term patency and major adverse cardiac events (MACE) among patients undergoing coronary artery bypass grafting (CABG) with the left internal mammary artery (LIMA), radial artery, or saphenous vein grafts (SVG) in a tertiary care hospital in Pakistan.

Methods: This retrospective cohort study included 225 patients who underwent isolated CABG between 2015 and 2022 at Imran Idrees Teaching Hospital, Sialkot. Patients were grouped according to the primary conduit used: LIMA (n=75), radial artery (n=75), or SVG (n=75). Demographic, clinical, and peri-operative data were extracted from hospital records. Outcomes assessed were graft patency on follow-up imaging and incidence of MACE, defined as death, myocardial infarction, stroke, or repeat revascularisation. Statistical analyses included chi-square tests, ANOVA, Kaplan–Meier survival curves, and multivariable logistic regression.

Results: The mean age of the cohort was 58 years, with 68% male patients. At follow-up, overall MACE incidence was 22%, varying by conduit type: LIMA 12%, radial artery 21%, and SVG 35% (p<0.001). Graft patency was highest for LIMA (95%), followed by radial artery (88%) and SVG (72%) (p<0.001). In adjusted analyses, radial artery (OR 2.5, p=0.014) and SVG (OR 3.4, p=0.001) conduits were independently associated with higher MACE risk compared with LIMA. Peri-operative ventilation time, ICU stay, and hospital stay were shortest for LIMA and longest for SVG recipients.

Conclusion: LIMA grafts provided superior patency and lower risk of MACE compared with radial artery and SVG conduits. Radial artery outcomes were intermediate, while SVGs were linked to the highest adverse event rates. Arterial conduits should be preferred in CABG whenever feasible, particularly in high-risk patients.