Predictors of vein graft disease progression between one week and one year after surgical coronary revascularization: Impact of secondary prevention medications

J Card Surg. 2022 Nov;37(11):3664-3672. doi: 10.1111/jocs.16895. Epub 2022 Sep 1.

Abstract

Objective: This study aimed to detect the predictors of vein graft disease (VGD) progression between 1 week and 1 year after surgery and to evaluate the impact of secondary prevention medications.

Methods: A total of 218 consecutive patients underwent surgical coronary revascularization were evaluated by coronary computed tomography angiography both at 1-week and 1-year follow-up. Logistic regression analyses were performed to investigate the predictors of VGD progression. A risk score (0-4) was set up to evaluate implementation result of secondary prevention measures according to 1-year follow-up result. Association between VGD progression and the risk score was assessed.

Results: VGD progression occurred in 11.3% of saphenous vein grafts (SVG) and 22.1% of patients. At the patient level, poor vein graft (odds ratio [OR] = 4.25), noncontrolled hyperlipidemia (OR = 3.01), and diabetes mellitus (DM) (OR = 2.96) were predictors, while diameter of SVG (mm, OR = 0.35) was protective factor. At the graft level, DM (OR = 3.52), noncontrolled hyperlipidemia (OR = 2.33), and peripheral artery disease (PAD) (OR = 2.20) were predictors, while number of SVGs (OR = 0.63), diameter of SVG (mm, OR = 0.39), and mean graft flow >25 ml/min (OR = 0.35) were protective factors. VGD progression was significantly associated with the risk score at both the patient (OR = 1.52) and the graft level (OR = 1.38).

Conclusions: Poor vein graft, noncontrolled hyperlipidemia and DM were predictors of VGD progression between 1 week and 1 year after surgery at the patient level, while larger SVG diameter was a protective factor. DM, PAD and noncontrolled hyperlipidemia were predictors at the graft level, while a number of SVGs, larger SVG diameter, and mean graft flow >25 ml/min were protective factors. Implementation failure of secondary prevention medications was associated with VGD progression from as early as 1 year after surgery.

Keywords: coronary artery bypass grafting; coronary artery disease; secondary prevention; vein graft failure.

MeSH terms

  • Coronary Angiography
  • Coronary Artery Bypass* / methods
  • Disease Progression
  • Follow-Up Studies
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / prevention & control
  • Humans
  • Saphenous Vein* / transplantation
  • Secondary Prevention
  • Treatment Outcome
  • Vascular Patency