Fate of Grafts Bypassing Nonischemic Versus Ischemic Inducing Coronary Stenosis

• Published in: The American journal of cardiology 2018-10, Vol.122 (7), p.1148-1154
• Main Authors: Roh, Jae-Hyung, Kim, Young-Hak, Yang, Dong Hyun, Han, Seungbong, Yun, Sung-Cheol, Yang, Dong Heon, Park, Gyung-Min, Lee, Pil Hyung, Ahn, Jung-Min, Kang, Joon-Won, Lim, Tae-Hwan, Moon, Dae Hyuk, Kim, Joon Bum, Jung, Sung-Ho, Chung, Cheol Hyun, Choo, Suk Jung, Lee, Jae Won, Kang, Soo-Jin, Park, Duk-Woo, Lee, Seung-Whan, Lee, Cheol Whan, Park, Seong-Wook, Park, Seung-Jung
• Format: Article
• Language: English
• Subjects: Angiography; Clinical outcomes; Computed tomography; Computed Tomography Angiography; Confidence intervals; Coronary Angiography; Coronary artery; Coronary Artery Bypass - methods; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - surgery; Coronary vessels; Defects; Failure; Female; Graft rejection; Graft Rejection - epidemiology; Grafting; Grafts; Humans; Incidence; Ischemia; Male; Medical imaging; Middle Aged; Multivariate analysis; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - surgery; Myocardial Perfusion Imaging; Occlusion; Patients; Perfusion; Prospective Studies; Registries; Republic of Korea - epidemiology; Risk Assessment; Risk Factors; Stenosis; Surgery; Thorax; Tomography; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.06.028

There is a lack of evidence regarding the efficacy of ischemia-guided coronary artery bypass grafting. We compared the incidence of graft failure between grafts bypassing ischemia-inducing and nonischemia-inducing stenoses. Between 1997 and 2011, 2,304 patients for whom baseline coronary angiography and myocardial perfusion imaging were available were identified from a single-center coronary artery bypass grafting registry. According to baseline myocardial perfusion imaging, each graft was assigned to either graft bypassing ischemia-inducing or nonischemia-inducing stenoses (ischemia-related grafts, n = 4,904; ischemia-unrelated grafts, n = 2,709). Graft failure was defined as total occlusion on coronary computed tomography angiography, performed at the discretion of the treating physician. The incidence of graft failure was compared on a per-graft basis. At 5 years, the incidence of graft failure was significantly higher in the ischemia-unrelated grafts (4.2% vs 2.9% in ischemia-related grafts; p = 0.003). Ischemia-related graft was an independent determinant of graft patency (adjusted hazard ratio 0.61; 95% confidence interval 0.44 to 0.84; p = 0.002). Increased risk of graft failure associated with ischemia-unrelated graft was observed only in the internal thoracic artery (3.3% vs 2.0%, p = 0.021) and arterial grafts (6.5% vs 4.3%, p = 0.020), but not in the venous grafts (2.7% vs 2.7%; p = 0.99). In terms of major adverse cardiac and cerebrovascular events, 5-year incidences were comparable between the patients with and without ischemia-unrelated grafts (219, 19.3% vs 160, 18.0%; p = 0.61). In conclusion, ischemia-unrelated grafts became dysfunctional more frequently than ischemia-related grafts, and were not preventive of adverse events.