Influential Factors for Graft Patency after Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Chang , XIAO Xigang , WANG Baichun , WU Dan , XU Lei , LIU Hongyu.

1.Department of Cardiovascular Surgery， First Affiliated Hospital of Harbin Medical University， Harbin 150001， P. R. China;;
2. Department of Computer Tomography， First Affiliated　Hospital of Harbin Medical University， Harbin 150001， P.R.China;

Corresponding author：

Keywords：

Coronary artery bypass grafting; 　Graft; 　 Patency; 　Risk factor

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Abstract：　Objective　To evaluate graft patency at one year after coronary artery bypass grafting （CABG） and analyze the risk factors of graft occlusion.　Methods　We prospectively included 71 consecutive patients with coronary heart disease who underwent CABG in First Affiliated Hospital of Harbin Medical University from June to December 2010. There were 37 males and 34 females with their average age of 59.8±7.7 years. All the patients underwent CABG　performed by the same surgeon， and received standard drug therapy after surgery. At 1 year after CABG， 256-slice multislice computed tomography （MSCT） angiography was performed to evaluate graft patency. All the patients were divided into two groups according to their graft patency during follow-up， including 16 patients in the occluded graft group and 55　patients in patent graft group. Preoperative， intra-operative and postoperative variables were collected. Univiariate analysis　and logistic regress analysis were performed to analyze risk factors of graft occlusion.　Results　The graft patency was 91.0% （172/189） at 1 year after CABG. Univiariate analysis showed that pre-operative cholesterol （t=-2.389，P=0.017）， diffused coronary artery disease （χ2=4.449，P=0.042）， diameter of target vessels （t=5.064，P=0.000）， non-adherence to prescribed antiplatelet medications （χ2=10.175，P=0.008） were potential risk factors of graft occlusion after CABG. Logistic　regress analysis showed that diameter of target vessels ［RR=0.014，95% CI （0.001，0.229），P=0.003］ and non-adherence to prescribed antiplatelet medications ［RR=13.375，95% CI （1.075，175.536），P=0.044］ were significant risk factors for graft occlusion.　Conclusion　The graft patency is satisfactory at 1 year after CABG. Graft patency after CABG is closely　related to the stenosis degree of target vessels and adherence to prescribed antiplatelet medications after surgery.

Citation： LIU Chang,XIAO Xigang,WANG Baichun,WU Dan,XU Lei,LIU Hongyu.. Influential Factors for Graft Patency after Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 606-609. doi: Copy

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9.	Motwani JG， Topol EJ. Aortocoronary saphenous vein graft disease：pathogenesis， predisposition， and prevention. Circulation， 1998， 97 （9）：916-931.
10.	Gum PA， Kottke-Marchant K， Welsh PA， et al. A prospective， blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol，　2003， 41 （6）：961-965.
11.	Gurbuz AT， Zia AA， Vuran AC， et al. Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery：a prospective study. Eur J Cardiothorac Surg， 2006， 29 （2）：190-195.
12.	Yusuf S， Zhao F， Mehta SR， et al. Effects of clopidogrel in　addition to aspirin in patients with acute coronary syndromes without　ST-segment elevation. N Engl J Med， 2001， 345 （7）：494-502.
13.	CAPRIE Steering Committee. A randomised， blinded， trial of clopidogrel versus aspirin in patients at risk of ischaemic events （CAPRIE）. CAPRIE Steering Committee. Lancet，1996，348 （9038）：1329-1339.
14.	Cadroy Y， Bossavy JP， Thalamas C， et al. Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans. Circulation， 2000， 101 （24）：2823-2828.
15.	Fox KA， Mehta SR， Peters R， et al. Benefits and risks of the　combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome：the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events （CURE） Trial. Circulation， 2004， 110 （10）：1202-1208.
16.	Gao G， Zheng Z， Pi Y， et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center， randomized， controlled trial. J Am Coll Cardiol， 2010， 56 （20）：1639-1643.
17.	Goldman S， Zadina K， Moritz T， et al. Long-term patency of　saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery：results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol， 2004， 44 （11）：2149-2156.
18.	Mitka M. Beat goes on in “off-pump” bypass surgery：surgeon experience may be key to best outcome. JAMA， 2004， 291 （15）：1821-1822.

1. 　Garcia MJ， Lessick J， Hoffmann MH， et al. Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. J Am Med Assoc， 2006， 296 （4）：403-411.
2. 　Henderson ER， Pocock SJ， Sharp SJ， et al. Long-term results of RITA-1 trial clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina. Lancet， 1998， 352 （9138）：1419-1425.
3. 　宋玮，金叔宣，杜勇平，等．16排CT对冠状动脉桥血管病变评估的临床应用价值．中华心血管病杂志， 2005， 33 （8）：704-707．.
4. 　Yamamoto M， Kimura F， Niinami H， et al. Noninvasive assessment of off-pump coronary artery bypass surgery by 16-channel multidetector-row computed tomography. Ann Thorac Surg， 2006， 81 （3）：820-827.
5. 　Pache G， Saueressig U， Frydrychowicz A， et al. Initial experience with 64-slice cardiac CT：non-invasive visualization of coronary　artery bypass grafts. Eur Heart J， 2006， 27 （8）：976-980.
6. 　Manninen HI， Jaakkola P， Suhonen M， et al. Angiographic predictors of graft patency and disease progression after coronary artery bypass grafting with arterial and venous grafts. Ann Thorac Surg， 1998， 66 （4）：1289-1294.
7. 　Berger A， Maccarthy PA， Siebert U， et al. Long-term patency of　internal mammary artery bypass grafts：relationship with preoperative severity of the native coronary artery stenosis. Circulation， 2004， 110 （11 Supp l1）：II36-II40.
8. 　Goldman S， Copeland J， Moritz T， et al. Improvement in early　saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy：results of a Veterans Administration Cooperative Study. Circulation， 1988， 77 （6）：1324-1332.
9. 　Motwani JG， Topol EJ. Aortocoronary saphenous vein graft disease：pathogenesis， predisposition， and prevention. Circulation， 1998， 97 （9）：916-931.
10. 　Gum PA， Kottke-Marchant K， Welsh PA， et al. A prospective， blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol，　2003， 41 （6）：961-965.
11. 　Gurbuz AT， Zia AA， Vuran AC， et al. Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery：a prospective study. Eur J Cardiothorac Surg， 2006， 29 （2）：190-195.
12. 　Yusuf S， Zhao F， Mehta SR， et al. Effects of clopidogrel in　addition to aspirin in patients with acute coronary syndromes without　ST-segment elevation. N Engl J Med， 2001， 345 （7）：494-502.
13. 　CAPRIE Steering Committee. A randomised， blinded， trial of clopidogrel versus aspirin in patients at risk of ischaemic events （CAPRIE）. CAPRIE Steering Committee. Lancet，1996，348 （9038）：1329-1339.
14. 　Cadroy Y， Bossavy JP， Thalamas C， et al. Early potent antithrombotic effect with combined aspirin and a loading dose of clopidogrel on experimental arterial thrombogenesis in humans. Circulation， 2000， 101 （24）：2823-2828.
15. 　Fox KA， Mehta SR， Peters R， et al. Benefits and risks of the　combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome：the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events （CURE） Trial. Circulation， 2004， 110 （10）：1202-1208.
16. 　Gao G， Zheng Z， Pi Y， et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center， randomized， controlled trial. J Am Coll Cardiol， 2010， 56 （20）：1639-1643.
17. 　Goldman S， Zadina K， Moritz T， et al. Long-term patency of　saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery：results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol， 2004， 44 （11）：2149-2156.
18. 　Mitka M. Beat goes on in “off-pump” bypass surgery：surgeon experience may be key to best outcome. JAMA， 2004， 291 （15）：1821-1822.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influential Factors for Graft Patency after Coronary Artery Bypass Grafting

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