Key result
Endoscopic vein harvesting is linked to ~41% higher odds of vein graft failure post-CABG.
Why the study?
Coronary artery bypass grafting success is limited by vein graft failure, and understanding the factors associated with VGF may improve patient outcomes.
What patient and surgical factors are associated with angiographic saphenous vein graft failure 12 to 18 months after coronary artery bypass grafting?
Cohort (n=1,828)
What patient and surgical factors are associated with angiographic saphenous vein graft failure 12 to 18 months after coronary artery bypass grafting?
Answers are grounded in this paper and cite their sources.
Saphenous vein graft failure occurs in 42.8% of patients within 12 to 18 months after CABG and is strongly associated with surgical factors such as endoscopic vein harvesting, poor target artery quality, and longer operative duration.
BACKGROUND: Coronary artery bypass grafting success is limited by vein graft failure (VGF). Understanding the factors associated with VGF may improve patient outcomes. METHODS AND RESULTS: We examined 1828 participants in the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial undergoing protocol-mandated follow-up angiography 12 to 18 months post-coronary artery bypass grafting or earlier clinically driven angiography. Outcomes included patient- and graft-level angiographic VGF (≥75% stenosis or occlusion). Variables were selected by using Fast False Selection Rate methodology. We examined relationships between variables and VGF in patient- and graft-level models by using logistic regression without and with generalized estimating equations. At 12 to 18 months post-coronary artery bypass grafting, 782 of 1828 (42.8%) patients had VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and clinical characteristics were similar between patients with and without VGF, although VGF patients had longer surgical times, worse target artery quality, longer graft length, and they more frequently underwent endoscopic vein harvesting. After multivariable adjustment, longer surgical duration (odds ratio per 10-minute increase, 1.05; 95% confidence interval, 1.03-1.07), endoscopic vein harvesting (odds ratio, 1.41; 95% confidence interval, 1.16-1.71), poor target artery quality (odds ratio, 1.43; 95% confidence interval, 1.11-1.84), and postoperative use of clopidogrel or ticlopidine (odds ratio, 1.35; 95% confidence interval, 1.07-1.69) were associated with patient-level VGF. The predicted likelihood of VGF in the graft-level model ranged from 12.1% to 63.6%. CONCLUSIONS: VGF is common and associated with patient and surgical factors. These findings may help identify patients with risk factors for VGF and inform the development of interventions to reduce VGF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00042081.
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Hess et al. (2014) conducted a cohort in Coronary artery bypass grafting (CABG) with saphenous vein grafts (n=1,828). Patient and surgical factors (endoscopic vein harvesting, longer surgical duration, poor target artery quality, postoperative clopidogrel or ticlopidine use) vs. Absence of risk factors (e.g., open vein harvesting, shorter surgical duration, good target artery quality) was evaluated on Patient- and graft-level angiographic vein graft failure (≥75% stenosis or occlusion) at 12 to 18 months (OR 1.41, 95% CI 1.16-1.71). Endoscopic vein harvesting, poor target artery quality, and longer surgical time were associated with vein graft failure at 12-18 months.
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