Native Coronary Disease Progression Post Coronary Artery Bypass Grafting
Related Experiment Video
Updated: Jan 23, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Habib Jabagi1, Aun-Yeong Chong2, Derek So2
1Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Insights
Graft type does not impact native coronary artery disease progression after coronary artery bypass grafting (CABG). However, venous graft use was linked to non-left main coronary occlusion, suggesting potential benefits of arterial grafts.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- The impact of graft type on native coronary artery disease progression post-coronary artery bypass grafting (CABG) remains incompletely understood.
- Native disease progression in target coronary arteries after CABG is a critical factor influencing long-term outcomes.
Purpose of the Study:
- To investigate whether the type of graft used in CABG influences the progression of native coronary artery disease in bypassed vessels.
- To identify factors associated with native coronary artery disease progression and occlusion post-CABG.
Main Methods:
- Retrospective analysis of 98 patients undergoing repeat angiography at least 6 months post-CABG with at least one arterial graft.
- Angiograms were assessed for native disease progression, defined by new stenosis, increased stenosis severity, or new occlusion.
- Cox-proportional hazard regression models were employed to analyze time-to-event outcomes.
Main Results:
- Native coronary artery disease progression occurred in 34.6% of target vessels, with 28.5% progressing to complete occlusion.
- Graft choice was not significantly associated with overall native disease progression (p=0.163).
- Progression to occlusion was significantly associated with saphenous vein graft (SVG) use (p=0.019), previous percutaneous coronary intervention (p=0.007), and ACE inhibitor use (p<0.001).
Conclusions:
- Native coronary artery disease progression in non-left main coronaries is multifactorial.
- Saphenous vein graft use was specifically associated with the occlusion of non-left main coronaries.
- Consideration for increased arterial grafting and further investigation into the roles of previous PCI and ACE inhibitor use are warranted.
Background:
It remains unclear if graft type impacts native disease progression in the target coronary artery post coronary artery bypass grafting (CABG).
Methods:
Patients who underwent repeat angiograms at least 6 months post CABG with ≥1 arterial graft were included. Pre/post CABG angiograms were examined by 2 experienced readers. Progression was defined as new stenosis of ≥50% in a previously normal coronary, an increase in previous stenosis of ≥20%, or a new occlusion. Primary outcome was the occurrence of native disease progression in bypassed vessels. Secondary outcomes included complete occlusion, left main (LM) and distal disease progression. Cox-proportional hazard regression models were used for time-to-event outcomes.
Results:
Study population included 98 patients comprising 263 grafts (143 arterial/120 venous grafts). Median time from surgery to catheterization was 559 days (Interquartile Range 374,910).Ninety-one target vessels showed progression (34.6%) with 75 to complete occlusion (28.5%). Progression was not associated with graft choice (HR 0.74(0.49,1.13) p = 0.163),but was significantly associated with age(p = 0.034),previous PCI(p = 0.002),ACE inhibitor (ACEi) use(p < 0.001),CAD severity (p < 0.001),CCS class III/IV(p = 0.016) and NYHA class III/IV(p < 0.001). Progression to occlusion was significantly associated with SVG (p = 0.019), as well as previous percutaneous coronary intervention (p = 0.007) and ACEi use (p < 0.001). LM disease progression was significantly associated with peripheral vascular disease (HR 5.44(1.92, 15.46), p = 0.001), and not affected by graft type (p = 0.754).
Conclusions:
Native CAD progression in non-LM coronaries is multifactorial, while SVG use was only associated with occlusion of non-LM coronaries. The implications of this study warrant consideration for increased arterial grafting in CABG patients, while the negative associations of previous PCI and ACEi use carry important clinical implications, which require further investigation.
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