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Angiography-derived fractional flow reserve in predicting graft occlusions prior to bypass surgery
Maria Buske1, Natalie Fischer1, Tobias Kister1
1Department of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany.
Insights
Preoperative angiography-derived vessel fractional flow reserve (vFFR) accurately predicts graft occlusion after coronary artery bypass grafting (CABG). Higher vFFR values indicate increased risk, but graft occlusion did not impact long-term mortality.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Hemodynamics
Background:
- Coronary artery bypass grafting (CABG) is crucial for complex coronary artery disease.
- Graft occlusion is a significant complication impacting CABG outcomes.
- The role of fractional flow reserve (FFR) in CABG planning is not well-established.
Purpose of the Study:
- To evaluate the utility of angiography-derived vessel FFR (vFFR) in predicting graft occlusion post-CABG.
- To assess the correlation between preoperative vFFR and graft failure.
- To determine the relationship between graft occlusion and long-term all-cause mortality.
Main Methods:
- Retrospective analysis of 79 patients undergoing CABG (2005-2014).
- Calculation of preoperative and postoperative angiography-derived vFFR for native coronary vessels.
- Primary endpoint: graft occlusion; Secondary endpoint: all-cause mortality.
Main Results:
- Preoperative vFFR demonstrated strong predictive accuracy for graft occlusion (AUC 0.85).
- A vFFR threshold of 0.75 showed 90% sensitivity and 72% specificity for predicting occlusion.
- Higher preoperative vFFR values were significantly associated with an increased risk of graft occlusion.
Conclusions:
- Angiography-derived vFFR is a valuable, non-invasive tool for predicting graft occlusion risk before CABG.
- Elevated vFFR values pre-CABG signify a higher likelihood of graft failure.
- Graft occlusion after CABG was not found to be associated with increased long-term all-cause mortality in this cohort.
Background:
Coronary artery bypass grafting (CABG) is a key treatment for complex coronary artery disease, but graft occlusion can impact patient outcomes. Competitive flow from native coronary arteries is a known predictor of graft failure. While pressure-derived fractional flow reserve (FFR) guides percutaneous coronary interventions, its role in CABG planning remains unclear. Angiography-derived vessel FFR (vFFR) offers a non-invasive alternative, but its utility prior to CABG has not been well studied.
Methods:
We retrospectively analysed 79 patients undergoing CABG between 2005 and 2014, with pre- and post-CABG angiograms. vFFR was calculated for all major native vessels. The primary endpoint was graft occlusion; the secondary endpoint was all-cause mortality.
Results:
Among 132 grafts (93 arterial, 39 venous), preoperative vFFR predicted graft occlusion with an area under the curve of 0.85 (95% CI 0.75-0.94; p < 0.001). A threshold of 0.75 yielded 90% sensitivity and 72% specificity. Occluded grafts had higher vFFR values than patent ones (0.78 [IQR 0.63-0.93] vs. 0.57 [IQR 0.35-0.79; p < 0.001). In a univariate analysis, each 0.1-unit increase in vFFR was linked to a 2.78-fold higher risk of graft occlusion (95% CI 1.76-4.89; p < 0.001). Graft occlusion did not correlate with all-cause mortality (46.2% occluded vs. 43.8% non-occluded group, p = 0.84) after a median follow-up of 10.7 years.
Conclusions:
Preoperative angiography-derived vFFR can accurately predict graft occlusion after CABG, with higher vFFR values indicating greater risk. Graft occlusion was not associated with increased long-term mortality.
