Risk of New Native-Vessel Occlusion After Coronary Artery Bypass Grafting

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• 作者：Sung-Han Yoon ; MD^a ; Young-Hak Kim ; MD ; PhD^a ; ^{mdyhkim@amc.seoul.kr} ; Dong Hyun Yang ; MD ; PhD^b ; Jae-Hyung Roh ; MD^a ; Eun Young Lee ; MS^a ; Pil Hyung Lee ; MD^a ; Daisuke Sugiyama ; MD ; PhD^c ; Mineok Chang ; MD^a ; Jung-Min Ahn ; MD^a ; Won Jin Choi ; MD^b ; Joon-Won Kang ; MD ; PhD^b ; Tae-Hwan Lim ; MD ; PhD^b ; Joon Bum Kim ; MD ; PhD^d ; Sung-Ho Jung ; MD^d ; Cheol Hyun Chung ; MD ; PhD^d ; Suk Jung Choo ; MD ; PhD^d ; Jae Won Lee ; MD ; PhD^d ; Soo-Jin Kang ; MD ; PhD^a ; Duk-Woo Park ; MD ; PhD^a ; Seung-Whan Lee ; MD ; PhD^a ; Cheol Whan Lee ; MD ; PhD^a ; Seong-Wook Park ; MD ; PhD^a ; Seung-Jung Park ; MD ; PhD^a
• 刊名：The American Journal of Cardiology
• 出版年：2017
• 出版时间：1 January 2017
• 年：2017
• 卷：119
• 期：1
• 页码：7-13
• 全文大小：688 K
• 卷排序：119

文摘

Coronary computed tomography angiography is widely used to evaluate the graft patency, but information on the progression of native-vessel disease remains limited. We sought to evaluate the impact of bypass grafting on native-vessel progression after coronary artery bypass grafting. We evaluated new native-vessel occlusion defined as occlusion length ≥15 mm as a surrogate marker of native-vessel progression. We evaluated 911 patients with 2,271 nonoccluded vessels who underwent coronary artery bypass grafting and received follow-up coronary computed tomography angiography. Over a mean follow-up period of 4.7 years, the new occlusion rates were 9.2% for left anterior descending artery (LAD), and 13.9% for non-LAD, respectively. For non-LAD, new occlusion rate of vessels with bypass grafts was higher compared to those without bypass graft regardless of baseline native-vessel stenosis (intermediate stenosis: 8.6% vs 1.7%, p <0.001; severe stenosis: 20.5% vs 9.9%, p = 0.003). Furthermore, new occlusion rate of vessels with venous graft was the highest, followed by vessels with arterial graft and vessels without bypass graft, regardless of baseline stenosis (intermediate stenosis: 11.1% vs 5.2% vs 1.7%, p <0.001; severe stenosis: 23.7% vs 15.9% vs 9.9%, p <0.001). By multivariate analysis, bypass grafting was associated with new native-vessel occlusion for non-LAD (odds ratio 3.04, 95% confidence interval 1.79 to 5.14; p <0.001). Bypass graft was associated with new native-vessel disease progression regardless of baseline stenosis. In conclusion, the decision to bypass or leave a native vessel with intermediate stenosis should cautiously be considered.