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Published on: November 24, 2014
Risk of New Native-Vessel Occlusion After Coronary Artery Bypass Grafting
Sung-Han Yoon1, Young-Hak Kim1, Dong Hyun Yang2
1Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Insights
Coronary artery bypass grafting may accelerate native vessel disease progression, especially in non-left anterior descending arteries. Bypass grafts, particularly venous ones, were linked to increased new vessel occlusion, suggesting cautious consideration for grafting intermediate stenosis.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Imaging
Background:
- Coronary computed tomography angiography (CCTA) is vital for assessing bypass graft patency.
- Limited data exists on the impact of bypass grafting on native coronary artery disease progression.
- Understanding native vessel disease progression post-coronary artery bypass grafting (CABG) is crucial for patient management.
Purpose of the Study:
- To evaluate the effect of bypass grafting on the progression of native coronary artery disease.
- To identify if bypass grafting influences new vessel occlusion in native coronary arteries.
- To compare disease progression in grafted versus non-grafted native vessels.
Main Methods:
- Retrospective analysis of 911 patients undergoing CABG.
- Follow-up CCTA to assess new native-vessel occlusion (≥15 mm length).
- Evaluation of 2,271 non-grafted vessels over a mean follow-up of 4.7 years.
Main Results:
- New occlusion rates were 9.2% for left anterior descending artery (LAD) and 13.9% for non-LAD vessels.
- Non-LAD vessels with bypass grafts showed higher occlusion rates than those without (intermediate stenosis: 8.6% vs 1.7%; severe stenosis: 20.5% vs 9.9%).
- Venous grafts were associated with the highest new occlusion rates, followed by arterial grafts and no grafts, irrespective of baseline stenosis.
Conclusions:
- Bypass grafting is associated with accelerated native coronary artery disease progression, particularly in non-LAD vessels.
- The presence and type of bypass graft (venous > arterial > none) influence native vessel occlusion rates.
- Clinical decisions regarding bypassing native vessels with intermediate stenosis require careful consideration due to potential accelerated disease progression.
Abstract:
Coronary computed tomography angiography is widely used to evaluate the graft patency, but information on the progression of native-vessel disease remains limited. We sought to evaluate the impact of bypass grafting on native-vessel progression after coronary artery bypass grafting. We evaluated new native-vessel occlusion defined as occlusion length ≥15 mm as a surrogate marker of native-vessel progression. We evaluated 911 patients with 2,271 nonoccluded vessels who underwent coronary artery bypass grafting and received follow-up coronary computed tomography angiography. Over a mean follow-up period of 4.7 years, the new occlusion rates were 9.2% for left anterior descending artery (LAD), and 13.9% for non-LAD, respectively. For non-LAD, new occlusion rate of vessels with bypass grafts was higher compared to those without bypass graft regardless of baseline native-vessel stenosis (intermediate stenosis: 8.6% vs 1.7%, p <0.001; severe stenosis: 20.5% vs 9.9%, p = 0.003). Furthermore, new occlusion rate of vessels with venous graft was the highest, followed by vessels with arterial graft and vessels without bypass graft, regardless of baseline stenosis (intermediate stenosis: 11.1% vs 5.2% vs 1.7%, p <0.001; severe stenosis: 23.7% vs 15.9% vs 9.9%, p <0.001). By multivariate analysis, bypass grafting was associated with new native-vessel occlusion for non-LAD (odds ratio 3.04, 95% confidence interval 1.79 to 5.14; p <0.001). Bypass graft was associated with new native-vessel disease progression regardless of baseline stenosis. In conclusion, the decision to bypass or leave a native vessel with intermediate stenosis should cautiously be considered.
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