Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Graft occlusion following coronary artery bypass grafting (CABG) is often linked to competitive flow from native coronary arteries.
• Assessing graft patency and disease progression is crucial for long-term patient outcomes after CABG.

Purpose of the Study:

• To evaluate the predictive capability of pre-CABG angiography-derived vessel fractional flow reserve (vFFR) for graft occlusion.
• To assess the relationship between pre-CABG vFFR and the progression of coronary artery disease (CAD) in native vessels post-CABG using coronary computed tomography angiography (CCTA).

Main Methods:

• Serial vFFR analyses were performed on native coronary vessels before CABG in 171 patients between 2006 and 2018.
• Follow-up CCTA was conducted to assess graft occlusion and native vessel CAD progression.
• Statistical analysis correlated preoperative vFFR values with observed graft outcomes and disease progression.

Main Results:

• A total of 298 grafted and 59 non-grafted vessels were analyzed. Graft occlusion was identified in 28 of 298 grafts.
• Preoperative vFFR was significantly higher in occluded grafts compared to patent grafts (0.75 vs. 0.60, P < 0.001).
• A vFFR cutoff of 0.67 best predicted graft occlusion. CAD progression was significantly higher in grafted vessels (89.6%) versus non-grafted vessels (47.5%), with pre-CABG vFFR predicting progression in grafted vessels (AUC = 0.83).

Conclusions:

• Preoperative vFFR derived from invasive coronary angiography is a valuable tool for predicting graft occlusion after CABG.
• vFFR also effectively predicts the progression of coronary artery disease in grafted native arteries, informing surgical planning and risk stratification.