Predictors of graft patency 3 years after coronary artery bypass graft surgery. Department of Veterans Affairs Cooperative Study Group No. 297

Department of Veterans Affairs Medical Center and the University of Arizona Heart Center, Tucson 85723, USA.

OBJECTIVES: The purpose of this analysis was to define the factors that predict 3-year graft patency. BACKGROUND: The success of coronary artery bypass graft surgery (CABG) is dependent on vein graft patency after the operation. It has been well established by a series of Department of Veterans Affairs Cooperative Trials that aspirin (325 mg daily) improves saphenous vein graft patency early (7 to 10 days) and at 1 year, but not at 3 years after CABG. This analysis, based on one of these trials, defined factors that predict 3-year graft patency. METHODS: This analysis consisted of 266 patients, with 656 grafts that were patent 7 to 10 days after the operation, who underwent 3-year catheterization. To determine which patient-specific and/or graft-specific factors, or both, predict graft occlusion, a multivariate logistic regression analysis in terms of latent variables was used. It yielded a model that also took into account possible intraclass correlations. RESULTS: For a vein graft that was patent at 7 to 10 days after the operation, the positive predictors, according to univariate analysis, for that graft being patent at 3 years were cross-clamp time < or = 80 min (p < 0.001), vein preservation solution temperature < or = 5 degrees C (p = 0.009), bypass time < or = 2 h (p = 0.042), number of proximal anastomoses < or = 2 (p = 0.018), operation time < or = 5 h (p = 0.044) and continuous versus intermittent cross-clamp technique (p = 0.024). There was also a trend with regard to recipient artery diameter > 1.5 mm (p = 0.063), serum cholesterol < or = 225 mg/dl (p = 0.084) and single versus sequential or Y vein graft (p = 0.060). Factors not predictive of 3-year patency were age, race, smoking history, high density lipoprotein cholesterol, vein source (thigh vs. calf), coronary artery grafted and aspirin treatment. Of all the predictors obtained in the univariate analysis, the only variables that were sufficient to yield a good model within the multivariate analysis were solution temperature (p = 0.004), serum cholesterol (p = 0.024), number of proximal anastomoses (p = 0.032) and recipient artery diameter (p = 0.034). CONCLUSIONS: For a patient with patent vein grafts 7 to 10 days after the operation, predictors of 3-year graft patency are more closely related to operative techniques and underlying disease and not to aspirin treatment.

This article has been cited by other articles:

				R. H. Mehta, T. B. Ferguson, R. D. Lopes, G. E. Hafley, M. J. Mack, N. T. Kouchoukos, C. M. Gibson, R. A. Harrington, R. M. Califf, E. D. Peterson, et al. Saphenous Vein Grafts With Multiple Versus Single Distal Targets in Patients Undergoing Coronary Artery Bypass Surgery: One-Year Graft Failure and Five-Year Outcomes From the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial Circulation, July 19, 2011; 124(3): 280 - 288. [Abstract] [Full Text] [PDF]

				R. C. Welsh, C. B. Granger, C. M. Westerhout, J. C. Blankenship, D. R. Holmes Jr, W. W. O'Neill, C. W. Hamm, F. Van de Werf, P. W. Armstrong, and on behalf of APEX AMI Investigators Prior Coronary Artery Bypass Graft Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention J. Am. Coll. Cardiol. Intv., March 1, 2010; 3(3): 343 - 351. [Abstract] [Full Text] [PDF]

				E. Apostolakis and K. Akinosoglou Is the use of at least one internal thoracic artery (ITA) directly associated with increased long-term cardiac-specific survival? Eur J Cardiothorac Surg, April 1, 2009; 35(4): 747 - 748. [Full Text] [PDF]

				S.K. Payeli, R. Latini, C. Gebhard, A. Patrignani, U. Wagner, T.F. Luscher, and F.C. Tanner Prothrombotic Gene Expression Profile in Vascular Smooth Muscle Cells of Human Saphenous Vein, but Not Internal Mammary Artery Arterioscler Thromb Vasc Biol, April 1, 2008; 28(4): 705 - 710. [Abstract] [Full Text] [PDF]

				S. Goldman, K. Zadina, T. Moritz, T. Ovitt, G. Sethi, J. G. Copeland, L. Thottapurathu, B. Krasnicka, N. Ellis, R. J. Anderson, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2149 - 2156. [Abstract] [Full Text] [PDF]

				P. D. Stein, H. J. Schunemann, J. E. Dalen, and D. Gutterman Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 600S - 608S. [Abstract] [Full Text] [PDF]

				J. Dunning and S. Das What is the optimal dose of aspirin after discharge following coronary bypass surgery Interact CardioVasc Thorac Surg, December 1, 2003; 2(4): 427 - 430. [Abstract] [Full Text] [PDF]

				L. Holmvang, B. Jurlander, C. Rasmussen, J. J. Thiis, P. Grande, and P. Clemmensen Use of Biochemical Markers of Infarction for Diagnosing Perioperative Myocardial Infarction and Early Graft Occlusion After Coronary Artery Bypass Surgery Chest, January 1, 2002; 121(1): 103 - 111. [Abstract] [Full Text] [PDF]

				B. H. Walpoth, M. Pavlicek, B. Celik, B. Nicolaus, T. Schaffner, U. Althaus, O. M. Hess, T. Carrel, and R. E. Morris Prevention of neointimal proliferation by immunosuppression in synthetic vascular grafts Eur J Cardiothorac Surg, April 1, 2001; 19(4): 487 - 492. [Abstract] [Full Text] [PDF]

				P. D. Stein, J. E. Dalen, S. Goldman, and P. Theroux Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts Chest, January 1, 2001; 119(2009): 278S - 282S. [Full Text] [PDF]

				M. Rinia-Feenstra, W. Stooker, R. de Graaf, J. J. Kloek, M. Pfaffendorf, B. A.J.M. de Mol, and P. A. van Zwieten Functional properties of the saphenous vein harvested by minimally invasive techniques Ann. Thorac. Surg., April 1, 2000; 69(4): 1116 - 1120. [Abstract] [Full Text] [PDF]