Circ Cardiovasc Interv

Radial artery graft patency improved with antispastic agents

March 27, 2025

Nicorandil* and isosorbide mononitrate may be more effective than diltiazem in reducing radial artery (RA) graft failure post-coronary artery bypass grafting (CABG). Larger trials are warranted to confirm the findings and potentially influence clinical practice.

Study details: The ASRAB-Pilot trial (NCT04310995) was a single-center, randomized, open-label, parallel-group study that included 150 patients who underwent CABG using RA grafts. Patients were randomized to receive oral nicorandil (15 mg daily), isosorbide mononitrate (50 mg daily), or diltiazem (180 mg daily) for 24 weeks post-CABG. The primary outcome was RA graft failure at 1 and 24 weeks, assessed by coronary CT angiography.

Results: At one-week post-CABG, RA graft failure rates were lower with nicorandil (19.4%) and isosorbide mononitrate (18.2%) compared with diltiazem (25.0%). At 24 weeks, RA graft failure rates were significantly lower with isosorbide mononitrate (12.5%) compared with diltiazem (27.8%), and lower with nicorandil (16.1%) compared with diltiazem (27.8%).

*Nicorandil is not available in the U.S.

Source:

Zhu Y, et al. (2025, March 24). Circ Cardiovasc Interv. Effects of Nicorandil, Isosorbide Mononitrate, or Diltiazem on Radial Artery Grafts After CABG: The Randomized ASRAB-Pilot Trial. https://pubmed.ncbi.nlm.nih.gov/40123490/