Does the Right Internal Thoracic Artery or Saphenous Vein Graft Offer Superior Revascularization of the Right Coronary Artery?

A best evidence topic was written according to a structured protocol. The question addressed was whether the right internal thoracic artery (RITA) provides a superior outcome for revascularization of the right coronary artery (RCA) compared with the saphenous vein graft (SVG). Using a designated search strategy, 226 articles were found, of which five represented the best available evidence. The authors, journal, date, country of publication, study type, patient group studied, relevant outcomes and results were tabulated. Of these five studies, one offered level I evidence (data from a randomized trial) and four were level II studies (reports of observational data). The outcome measures varied considerably, but most included graft patency at varying levels of the follow-up. The randomized data showed strong evidence favouring the SVG, mainly in terms of mid-term patency. With the exception of a large cohort study that demonstrated the superior patency of the RITA compared with the SVG in the right coronary territory, the observational studies showed better results for SVG in graft patency, reintervention and cardiovascular complication rate. Overall, and in view of the methodological limitations and the different weight of evidence among studies, it appears that the SVG may offer a superior outcome for revascularization of the RCA when compared with the RITA.