CORONARY ARTERY DISEASE
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
Steven Goldman, MD, FACC*,*,
Karen Zadina, RN, MA*,
Thomas Moritz, MS ,
Theron Ovitt, MD*,
Gulshan Sethi, MD*,
Jack G. Copeland, MD*,
Lizy Thottapurathu, MS,
Barbara Krasnicka, PhD,
Nancy Ellis, MS,
Robert J. Anderson, PhD,
William Henderson, PhD VA Cooperative Study Group #207/297/364
* Southern Arizona VA Health Care System and the University of Arizona Sarver Heart Center, Tucson, Arizona
VA Cooperative Studies Program Coordinating Center, Hines, Illinois
Manuscript received May 6, 2004;
revised manuscript received August 16, 2004,
accepted August 25, 2004.
* Reprint requests and correspondence: Dr. Steven Goldman, Cardiology Section (1-111C), Southern Arizona VA Health Care System, 3601 South 6th Avenue, Tucson, Arizona 85723 (Email: steven.goldman{at}med.va.gov).
OBJECTIVES: This study defined long-term patency of saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts.
BACKGROUND: This VA Cooperative Studies Trial defined 10-year SVG patency in 1,074 patients and left IMA patency in 457 patients undergoing coronary artery bypass grafting (CABG).
METHODS: Patients underwent cardiac catheterizations at 1 week and 1, 3, 6, and 10 years after CABG.
RESULTS: Patency at 10 years was 61% for SVGs compared with 85% for IMA grafts (p < 0.001). If a SVG or IMA graft was patent at 1 week, that graft had a 68% and 88% chance, respectively, of being patent at 10 years. The SVG patency to the left anterior descending artery (LAD) (69%) was better (p < 0.001) than to the right coronary artery (56%), or circumflex (58%). Recipient vessel size was a significant predictor of graft patency, in vessels >2.0 mm in diameter SVG patency was 88% versus 55% in vessels  2.0 mm (p < 0.001). Other positive significant predictors of graft patency were use of aspirin after bypass, older age, lower serum cholesterol, and lowest Canadian Functional Class (p < 0.001 to 0.058).
CONCLUSIONS: The 10-year patency of IMA grafts is better than SVGs. The 10-year patency for SVGs is better and the 10-year patency for IMA grafts is worse than expected. The 10-year patency of SVGs to the LAD is better than that to the right or circumflex. The best long-term predictors of SVG graft patency are grafting into the LAD and grafting into a vessel that is >2.0 mm in diameter.
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Abbreviations and Acronyms
| | CABG = coronary artery bypass graft | | CX = circumflex | | IMA = internal mammary artery | | LAD = left anterior descending | | RCA = right coronary artery | | SVG = saphenous vein graft |
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