Abstract 15473: The Use of Coronary Artery Bypass Grafts in Non-significant Lesions: Is There Harm to Patients?
Introduction: Studies have shown the negative impact of percutaneous coronary interventions in non-flow limiting lesions; however, similar effects have not been examined in the use of coronary artery bypass grafting.
Methods: Using data from the PREVENT IV trial, we assessed rates of graft failure (≥75%) and adjusted long-term clinical outcomes by degree of native vessel stenosis (> or ≤75%) at the time of CABG. Degree of native vessel stenosis was based on available categories in the PREVENT IV database. Differences in graft failure rates were assessed using the Cochran-Armitage trend test, while clinical outcomes were compared in a multivariable Cox proportional hazards model.
Results: Of 3,008 patients (including 10,298 grafts), 1,622 (54%) had one or more non-significant lesions bypassed. The use of bypass grafting varied by vessel and degree of stenosis - 95% of non-significant LAD lesions were bypassed, while 86% and 75% of non-significant left circumflex and right coronary artery lesions were bypassed, respectively. In the angiographic cohort (n=1,828 patients and 6,047 grafts), degree of stenosis was not associated with vein graft failure but was associated with internal mammary artery graft failure (Table). The bypass of a non-significant lesion was not associated with death or the composite of death, MI, or revascularization.
Conclusion: The use bypass grafting to non-significant coronary lesions is common and is associated with higher degrees of IMA graft failure. We did not observe a relationship between bypassing of non-significant lesions and vein graft failure or clinical outcomes but had limited power to do so. Additional observational studies and adequate randomized clinical trials are necessary to define the optimal approach to surgical coronary revascularization.
Author Disclosures: B.R. Englum: None. P.J. Schulte: None. B.C. Gulack: None. C.M. Gibson: None. R.D. Lopes: None. M.J. Mack: None. T.B. Ferguson: None. R.A. Harrington: None. P.K. Smith: None. J.H. Alexander: None.
- © 2014 by American Heart Association, Inc.