Saphenous Vein Graft Failure after Coronary Artery Bypass Surgery: Insights from PREVENT IV
Background—Coronary artery bypass grafting (CABG) success is limited by vein graft failure (VGF). Understanding factors associated with VGF may improve patient outcomes.
Methods and Results—We examined 1828 participants in the PREVENT IV trial undergoing protocol-mandated follow-up angiography 12-18 months post-CABG or earlier clinically-driven angiography. Outcomes included patient- and graft-level angiographic VGF (≥75% stenosis or occlusion). Variables were selected using Fast False Selection Rate methodology. We examined relationships between variables and VGF in patient- and graft-level models using logistic regression without and with generalized estimating equations. At 12-18 months post-CABG, 782 of 1828 (42.8%) patients had VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and clinical characteristics were similar between patients with and without VGF, though VGF patients had longer surgical times, worse target artery quality, longer graft length, and more frequently underwent endoscopic vein harvesting. After multivariable adjustment, longer surgical duration (odds ratio [OR] per 10-minute increase 1.05, 95% confidence interval [CI] 1.03-1.07), endoscopic vein harvesting (OR 1.41, 95% CI 1.16-1.71), poor target artery quality (OR 1.43, 95% CI 1.11-1.84), and postoperative use of clopidogrel or ticlopidine (OR 1.35, 95% CI 1.07-1.69) were associated with patient-level VGF. The predicted likelihood of VGF in the graft-level model ranged from 12.1-63.6%.
Conclusions—VGF is common and associated with a number of patient and surgical factors. These findings may help identify patients with risk factors for VGF and inform the development of interventions to reduce VGF.
Clinical Trial Registration Information—ClinicalTrials.gov. Identifier: NCT00042081.
- Received December 12, 2013.
- Revision received July 16, 2014.
- Accepted August 11, 2014.