Key result
Following single-vessel CABG with an internal thoracic artery graft, the 20-year cumulative incidence of clinically-driven angiography was 38.6%, with a failed graft reported in only 16.4% of cases.
Why the study?
Coronary events and symptom recurrence after CABG could stem from internal thoracic artery graft failure, other conduit failure, or native disease progression, leaving the contribution of ITA graft failure unclear.
Does internal thoracic artery graft failure account for the majority of recurrent symptoms following single-vessel CABG surgery?
Cohort (n=1,939)
Yes
Does internal thoracic artery graft failure account for the majority of recurrent symptoms following single-vessel CABG surgery?
Recurrent symptoms after single-vessel CABG are predominantly due to native coronary disease progression rather than ITA graft failure.
ITA failure accounts for few recurrent symptoms after single-vessel CABG; leaves open dominant roles for native progression or other conduits in hypothesis-generating registry data.
OBJECTIVES: Coronary events and disease recurrence following coronary artery bypass (CABG) surgery could derive from either failure in the internal thoracic artery (ITA) graft, failure in other conduits or progressive disease in the coronaries. We aim to estimate the contribution of ITA graft failure to the recurrence of symptoms after CABG surgery. METHODS: Within the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry, we identified patients who had coronary artery bypass grafting from 1997 to 2020 with a single-vessel ITA graft bypass. Deaths, postoperative incidence of coronary angiography and the presence of a failed graft at the time of the angiography were recorded. RESULTS: The study population consisted of 1939 patients with a mean follow-up time (SD) of 17.2 (5.6) years. The cumulative incidence (95% CI) at 20 years for a first clinically-driven postoperative angiography was 38.6% (36.2-41.1). A failed ITA graft was reported in 16.4% of the angiographies. CONCLUSIONS: A substantial part of recurrent symptoms of coronary artery disease do not seem to be related to ITA failure. Disease progression in the native coronary vessels may instead be the main driver of symptom recurrence.
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Janiec et al. (2023) conducted a cohort in Coronary artery disease requiring single-vessel CABG (n=1,939). Single-vessel coronary artery bypass grafting with internal thoracic artery graft was evaluated on Cumulative incidence of first clinically-driven postoperative angiography at 20 years (95% CI 36.2-41.1). Following single-vessel CABG with an internal thoracic artery graft, the 20-year cumulative incidence of clinically-driven angiography was 38.6%, with a failed graft reported in only 16.4% of cases.
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