HDL-Adjusted Inflammatory Ratios and Sequential Graft Configuration are Associated with Mid-Term Saphenous Vein Graft Occlusion in a Post-CABG Angiography Cohort

Background: Saphenous vein graft (SVG) failure limits long-term outcomes after coronary artery bypass grafting (CABG). HDL-adjusted inflammatory ratios, including the neutrophil-to-HDL ratio (NHDLr) and lymphocyte-to-HDL ratio (LHDLr), have emerged as markers of vascular inflammation, but their association with SVG occlusion in the post-CABG setting is unclear. We evaluated whether HDL-adjusted inflammatory ratios and sequential graft configuration are associated with mid-term SVG occlusion. Methods: This retrospective observational study included 190 post-CABG patients who underwent clinically indicated follow-up coronary angiography. Patients were categorized by the presence (n=72) or absence (n=118) of at least one occluded SVG. HDL-adjusted ratios were calculated from fasting blood tests obtained at the outpatient visit when angiography was planned. Multivariable logistic regression was used to identify independent predictors of SVG occlusion. Results: Patients with SVG occlusion had higher NHDLr (5.07 vs 4.41, p=0.006) and LHDLr (2.48 vs 2.15, p=0.012). Median time from CABG to index angiography was 40.9 months (IQR 23.5– 66.5). Sequential grafting was more frequent in the occlusion group (33.3% vs 11.9%, p< 0.001). In multivariable analysis, sequential grafting (adjusted OR 3.58, 95% CI 1.63– 7.85), female sex (OR 2.05, 95% CI 1.06– 3.94), NHDLr (OR 1.18, 95% CI 1.01– 1.38), and LHDLr (OR 1.39, 95% CI 1.04– 1.87) were independently associated with SVG occlusion. The combined model showed moderate discrimination (AUC 0.729). SVG occlusion was not associated with all-cause mortality during follow-up (p=0.566). Conclusion: In a post-CABG cohort undergoing follow-up angiography, elevated NHDLr and LHDLr and sequential grafting were independently associated with mid-term SVG occlusion. These findings support further validation of HDL-adjusted inflammatory ratios as accessible markers related to graft vulnerability in this setting.