Influence of stenosis between left anterior descending and diagonal arteries on long-term patency and ischemic events after coronary bypass surgery

Figures

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  iLAD stenosis severity is a significant predictor of ITA-LAD graft failure.

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  Figure 1. Relevant coronary segments. Stenosis severity was evaluated in 3 specific segments defined relative to the target bypassed diagonal artery (closest to the ITA-LAD anastomosis): ① iLAD: The LAD segment between the ITA-LAD anastomosis and the diagonal artery origin. ② Diagonal artery: The target diagonal artery itself. ③ pLAD: The LAD segment proximal to the diagonal artery origin, including the left main trunk. iLAD, Intervening left anterior descending artery; ITA, internal thoracic artery; LAD, left anterior descending artery; pLAD, proximal left anterior descending artery.

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  Figure 2. Kaplan–Meier analysis of freedom from ITA-LAD events stratified by stenosis severity in 3 distinct segments. The curves show the freedom from ITA-LAD events for the entire cohort, stratified by the stenosis severity of (A) the iLAD (①), (B) the diagonal artery (②), and (C) the pLAD (③), as defined in Figure 1. The shaded areas indicate 95% CI. ITA, Internal thoracic artery; LAD, left anterior descending.

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  Figure 3. Impact of iLAD stenosis on ITA-LAD graft events stratified by adjacent vessel stenosis. The curves show the freedom from ITA-LAD events for 4 subgroups defined by the combination of iLAD (①) stenosis severity and that of (A) the diagonal artery (②) or (B) the pLAD (③) as defined in Figure 1. The point estimates and 95% CI are presented in Table E1. ITA, Internal thoracic artery; LAD, left anterior descending.

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  Figure 4. Impact of diagonal graft configuration and its combined effect with iLAD stenosis on ITA-LAD events. Kaplan–Meier analyses showing freedom from ITA-LAD events stratified by (A) diagonal graft configuration (individual vs sequential) and (B) the combination of iLAD (①) stenosis severity, as defined in Figure 1, and diagonal graft configuration. The shaded areas in (A) indicate 95% CI. The point estimates and 95% CI for (B) are listed in Table E1. D, Diagonal artery; ITA, internal thoracic artery; LAD, left anterior descending.

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  Figure E1. Patient flow diagram. CABG, Coronary artery bypass grafting; iLAD, intervening left anterior descending artery; ITA, internal thoracic artery; LAD, left anterior descending; RITA, right internal thoracic artery.

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  Figure E2. Diagonal graft patency and sensitivity analyses. A, Diagonal graft patency by conduit (arterial grafts vs SVGs). B and C, Freedom from ITA-LAD events by iLAD stenosis severity in patients (B) without and (C) with diagonal graft failure. iLAD, Intervening left anterior descending artery; ITA, internal thoracic artery; LAD, left anterior descending artery; SVG, saphenous vein graft.

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  Figure E3. Sensitivity analysis by radial artery use. Kaplan–Meier analyses showing freedom from ITA-LAD events stratified by iLAD stenosis severity within the (A) with radial artery subgroup (n = 154) and (B) without radial artery subgroup (n = 342). P values were calculated using the log-rank test. CI = 95%. iLAD, Intervening left anterior descending artery; ITA, internal thoracic artery; LAD, left anterior descending artery.

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  Figure E4. Sensitivity analysis by internal thoracic artery side. Kaplan–Meier analyses showing freedom from ITA-LAD events stratified by iLAD stenosis severity within the (A) LITA-LAD subgroup (n = 346) and (B) RITA-LAD subgroup (n = 150). P values were calculated using the log-rank test. CI = 95%. iLAD, Intervening left anterior descending artery; ITA, internal thoracic artery; LAD, left anterior descending artery; LITA, left internal thoracic artery; RITA, right internal thoracic artery.

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  Figure E5. Relationship between intraoperative ITA-LAD graft flow and the probability of graft events. Scatter plot with a fitted logistic regression curve demonstrating the relationship between intraoperative transit-time graft flow and the predicted probability of ITA-LAD events (univariate logistic regression, P < .001; n = 485). ITA, Internal thoracic artery; LAD, left anterior descending artery.