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Randomized Controlled Trial
. 2014 Oct 21;130(17):1445-51.
doi: 10.1161/CIRCULATIONAHA.113.008193. Epub 2014 Sep 26.

Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV

Connie N Hess  1 , Renato D Lopes  1 , C Michael Gibson  1 , Rebecca Hager  1 , Daniel M Wojdyla  1 , Brian R Englum  1 , Michael J Mack  1 , Robert M Califf  1 , Nicholas T Kouchoukos  1 , Eric D Peterson  1 , John H Alexander  2
Affiliations
Randomized Controlled Trial

Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV

Connie N Hess et al. Circulation. .

Abstract

Background: Coronary artery bypass grafting success is limited by vein graft failure (VGF). Understanding the factors associated with VGF may improve patient outcomes.

Methods and results: We examined 1828 participants in the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial undergoing protocol-mandated follow-up angiography 12 to 18 months post-coronary artery bypass grafting or earlier clinically driven angiography. Outcomes included patient- and graft-level angiographic VGF (≥75% stenosis or occlusion). Variables were selected by using Fast False Selection Rate methodology. We examined relationships between variables and VGF in patient- and graft-level models by using logistic regression without and with generalized estimating equations. At 12 to 18 months post-coronary artery bypass grafting, 782 of 1828 (42.8%) patients had VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and clinical characteristics were similar between patients with and without VGF, although VGF patients had longer surgical times, worse target artery quality, longer graft length, and they more frequently underwent endoscopic vein harvesting. After multivariable adjustment, longer surgical duration (odds ratio per 10-minute increase, 1.05; 95% confidence interval, 1.03-1.07), endoscopic vein harvesting (odds ratio, 1.41; 95% confidence interval, 1.16-1.71), poor target artery quality (odds ratio, 1.43; 95% confidence interval, 1.11-1.84), and postoperative use of clopidogrel or ticlopidine (odds ratio, 1.35; 95% confidence interval, 1.07-1.69) were associated with patient-level VGF. The predicted likelihood of VGF in the graft-level model ranged from 12.1% to 63.6%.

Conclusions: VGF is common and associated with patient and surgical factors. These findings may help identify patients with risk factors for VGF and inform the development of interventions to reduce VGF.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00042081.

Keywords: coronary artery bypass; coronary disease; myocardial revascularization.

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Figures

Figure 1
Figure 1
Flowchart of patient selection for the final analysis population.
Figure 2
Figure 2
Distribution of predicted VGF risk. Shown is the distribution of predicted risk of VGF using the full (including 30-day medication use) graft-level VGF model among the patient cohort. Listed above each bar is the observed probability of VGF. IQR, interquartile range; VGF, vein graft failure.
See this image and copyright information in PMC

Comment in

References

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