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J Am Coll Cardiol, 2004; 44:2149-2156, doi:10.1016/j.jacc.2004.08.064
© 2004 by the American College of Cardiology Foundation
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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{dagger}, Theron Ovitt, MD*, Gulshan Sethi, MD*, Jack G. Copeland, MD*, Lizy Thottapurathu, MS{dagger}, Barbara Krasnicka, PhD{dagger}, Nancy Ellis, MS{dagger}, Robert J. Anderson, PhD{dagger}, William Henderson, PhD{dagger} VA Cooperative Study Group #207/297/364

* Southern Arizona VA Health Care System and the University of Arizona Sarver Heart Center, Tucson, Arizona
{dagger} 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.

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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