Abstract / Summary
Abstract Background This systematic review and meta-analysis compared the long-term efficacy and clinical outcomes of radial artery (RA) versus saphenous vein grafts (SVG) in coronary artery bypass grafting (CABG). Methods Following PRISMA guidelines, databases were searched through March 2026 for randomized controlled trials (RCTs) comparing RA and SVG for non-left anterior descending coronary arteries. The primary outcome was graft failure, defined as a composite of complete or functional occlusion (string sign). Results Four RCTs assessing 1,219 grafts (621 RA; 598 SVG) were included. No statistically significant differences were found between RA and SVG in overall graft failure (12.4% vs. 14.9%; P = .11) or patency rates (87.6% vs. 85.1%; P = .11). However, RA grafts demonstrated significantly lower odds of complete occlusion (7.1% vs. 13.9%; P = .046) but a 6-fold higher risk of functional occlusion (6.1% vs. 0.8%; P < .001). Leave-one-out sensitivity analysis revealed that omitting one outlier study eliminated heterogeneity and shifted primary outcomes significantly in favor of RA grafts. No significant differences were observed for all-cause mortality (P = .13) or repeat revascularization (P = .37). Conclusion Neither conduit is universally superior. RA grafts reduce complete anatomical occlusion but are highly susceptible to competitive flow-induced functional occlusion. Graft selection should be individualized based on patient demographics and target vessel characteristics.