Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-01, Vol.133 (2), p.131-138
• Main Authors: Harskamp, Ralf E, Alexander, John H, Ferguson, T Bruce, Hager, Rebecca, Mack, Michael J, Englum, Brian, Wojdyla, Daniel, Schulte, Phillip J, Kouchoukos, Nicholas T, de Winter, Robbert J, Gibson, C Michael, Peterson, Eric D, Harrington, Robert A, Smith, Peter K, Lopes, Renato D
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Catheterization; Cardiovascular Agents - therapeutic use; Combined Modality Therapy; Comorbidity; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - drug therapy; Coronary Disease - surgery; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - epidemiology; Diabetes Complications - epidemiology; Diabetes Complications - surgery; Double-Blind Method; Female; Graft Occlusion, Vascular - epidemiology; Humans; Internal Mammary-Coronary Artery Anastomosis - adverse effects; Internal Mammary-Coronary Artery Anastomosis - statistics & numerical data; Kaplan-Meier Estimate; Male; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction - epidemiology; Postoperative Complications - mortality; Proportional Hazards Models; Randomized Controlled Trials as Topic; Reoperation; Treatment Failure
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.115.015549

BACKGROUND—The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. METHODS AND RESULTS—The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis