CLINICAL STUDY: CARDIAC SURGERY
Prognostic factors for atherosclerosis progression in saphenous vein grafts
The postcoronary artery bypass graft (post-CABG) trial
Michael J. Domanski, MD, FACC*,
Craig B. Borkowf, PhD ,
Lucien Campeau, MD, FACC ,
Genell L. Knatterud, PhD ,
Carl White, MD, FACC||,
Byron Hoogwerf, MD¶,
Yves Rosenberg, MD, MPH*,
Nancy L. Geller, PhD the Post-CABG Trial Investigators#
* Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Maryland Medical Research Institute, Baltimore, Maryland, USA
|| Division of Cardiology, University of Minnesota Hospital, Minneapolis, Minnesota, USA
¶ Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Cardiology, Montreal Heart Institute, Montreal, Canada
Manuscript received February 28, 2000;
revised manuscript received June 22, 2000,
accepted July 31, 2000.
Reprint requests and correspondence: Dr. Michael Domanski, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892
OBJECTIVES
The study was done to assess patients in the Post-Coronary Artery Bypass Graft (Post-CABG) trial to determine prognostic factors for atherosclerosis progression.
BACKGROUND
Saphenous vein grafts (SVGs) are effective in relieving angina and, in certain patient subsets, in prolonging life. However, the progression of atherosclerosis in many of these grafts limits their usefulness.
METHODS
The Post-CABG trial studied moderate versus aggressive lipid-lowering and low-dose warfarin versus placebo in patients with a history of coronary artery bypass surgery and found that more aggressive lipid lowering was effective in preventing progression of atherosclerosis in SVGs, but warfarin had no effect. Using variables measured at baseline, we sought the independent prognostic factors for atherosclerosis progression in SVGs, employing the statistical method of generalized estimating equations with a logit-link function.
RESULTS
Twelve independent prognostic factors for atherosclerosis progression were found. In the order of their importance they were: maximum stenosis of the graft at baseline angiography; years post-SVG placement; the moderate low-density lipoprotein–cholesterol (LDL-C) lowering strategy; prior myocardial infarction; high triglyceride level; small minimum graft diameter; low high-density lipoprotein–cholesterol (HDL-C); high LDL-C; high mean arterial pressure; low ejection fraction; male gender; and current smoking.
CONCLUSIONS
This study identified Post-CABG patient and SVG characteristics associated with saphenous vein graft atherosclerosis progression. These data provide a basis for rational risk factor management to prevent progression of SVG atherosclerosis.
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Abbreviations and Acronyms
| | CHD | = coronary heart disease | | GEE | = generalized estimating equation | | GLM | = generalized linear model | | HDL-C | = high-density lipoprotein cholesterol | | LDL-C | = low-density lipoprotein cholesterol | | Post-CABG | = Post-Coronary Artery Bypass Graft trial | | SAS | = Statistical Analysis System | | SVG | = saphenous vein graft |
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