Abstract 11451: Preoperative Syntax Score and Graft Patency After Off-pump Coronary Bypass Surgery
Introduction: We retrospectively examined the association between preoperative SYNTAX score and graft patency after off-pump CABG.
Methods and Results: Of 912 consecutive patients undergoing isolated CABG (906 by the off-pump technique) between 2002 and 2011, 217 asymptomatic patients had follow-up 320-slice CT angiography. Of this cohort, we studied 666 distal anastomoses of 189 patients in whom preoperative SYNTAX scores were obtained. A graft was defined as patent if it was not occluded on CT angiography. In sequential grafts, each segment was analyzed as a separate graft. All arterial conduits were harvested with the skeletonization technique and used as in-situ grafts except one right ITA. The mean interval from operation to angiogram was 4.7 ± 2.4 years, range 0.8-10.0 years. Kaplan-Meier estimated 8- year graft patency were 93.1 ± 2.4% for internal thoracic artery, 86.5 ± 6.7% for saphenous vein, and 86.2 ± 5.7% for right gastroepiploic artery. Of the total 666 distal anastomoses, 27 in 21 patients were occluded. No significant difference was found in the preoperative SYNTAX scores between the 21 patients with graft occlusion (mean 35.7; range 15.0-51.5) and the 168 patients without graft occlusion (mean 36.6; range 17.0-54.5) (unpaired t test, p = 0.872). There was no significant difference in patients with low (0-22, n = 17), medium (23-32, n = 51), and high (33 ≤, n = 121) SYNTAX scores in the incidence of graft occlusion (11.8%, 11.8%, and 10.7%, p for trend = 0.713) and major adverse cardiac event (5.9%, 7.8%, and 5.8%, p for trend = 0.421). Risk factors for graft occlusion, identified by multivariate regression model including preoperative SYNTAX scores, were target vessel proximal stenosis 50-75% (odds ratio, 3.56; 95% confidence interval, 1.47 to 8.74; p = 0.005) and lower estimated glomerular filtration rate (odds ratio, 1,23 per 10 mL/min/1.73 m2 decrease; 95% confidence interval, 1.10 to 1.58; p = 0.012).
Conclusions: Preoperative SYNTAX score is not associated with graft patency and the incidence of major adverse cardiac event. Target vessel proximal stenosis 50-75% and lower estimated glomerular filtration rate are independent risk factors for graft occlusion.
- © 2012 by American Heart Association, Inc.