Relationship Between Vein Graft Failure and Subsequent Clinical Outcomes After Coronary Artery Bypass Surgery

Abstract

Background Vein graft failure (VGF) is common after coronary artery bypass graft surgery, but its relationship with long-term clinical outcomes is unknown. In this retrospective analysis, we examined the relationship between VGF, assessed by coronary angiography 12 to 18 months after coronary artery bypass graft surgery, and subsequent clinical outcomes. Methods and Results Using the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database, we studied data from 1829 patients who underwent coronary artery bypass graft surgery and had an angiogram performed up to 18 months after surgery. The main outcome measure was death, myocardial infarction, and repeat revascularization through 4 years after angiography. VGF occurred in 787 of 1829 patients (43%). Clinical follow-up was completed in 97% of patients with angiographic follow-up. The composite of death, myocardial infarction, or revascularization occurred more frequently among patients who had any VGF compared with those who had none (adjusted hazard ratio, 1.58; 95% confidence interval, 1.21–2.06; P=0.008). This was due mainly to more frequent revascularization with no differences in death (adjusted hazard ratio, 1.04; 95% confidence interval, 0.71–1.52; P=0.85) or death or myocardial infarction (adjusted hazard ratio, 1.08; 95% confidence interval, 0.77–1.53; P=0.65). Conclusions VGF is common after coronary artery bypass graft surgery and is associated with repeat revascularization but not with death and/or myocardial infarction. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing coronary artery bypass graft surgery.

Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

“…1 Although CABG improves survival and symptoms in selected patients, 1-3 surgical success depends on the continued patency of grafts, and graft failure has been associated with worse outcomes. 4,5 Saphenous vein grafts remain the most widely used conduit during CABG, and rates of vein graft failure (VGF) during the first 12 to 18 months after surgery have been reported to be as high as 25%. 6-10 …”

Symptomatic graft failure and impact on clinical outcome after coronary artery bypass grafting surgery: Results from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry

“…[1][2][3] More importantly, investigators have demonstrated an association between early vein GF and adverse clinical events. [4][5][6] As such, total arterial revascularization has been advocated. 7 However, in clinical practice, this technique is commonly underused.…”

Disconnect Between Vein Graft Failure and Clinical Events After Coronary Artery Bypass Graft Surgery

“…1 In this issue of Circulation, Hess and colleagues 2 report insights from the PREVENT IV study on VGF after CABG surgery. This is the 11th study published in a major journal reporting results of the PREVENT IV study [3][4][5][6][7][8][9][10][11][12] and involves the same patients. The angiographic results were analyzed from different clinical angles.…”