Original article
Adult cardiac
Impact of Extracardiac Vascular Disease on Vein Graft Failure and Outcomes After Coronary Artery Bypass Surgery

https://doi.org/10.1016/j.athoracsur.2013.09.099Get rights and content

Background

While extracardiac vascular disease (ECVD), defined as a history of peripheral vascular disease (PVD) or cerebrovascular disease (CBVD), is common in patients undergoing coronary artery bypass graft (CABG) surgery, there are limited data available on the association between ECVD, vein graft failure (VGF), and clinical outcomes.

Methods

Using data from the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENTIV) trial (n = 3,014), 1-year angiographic follow-up and 5-year clinical outcomes (death, myocardial infarction, and revascularization) were determined in patients with and without ECVD. Logistic regression was used to assess risk of VGF. Generalized estimating equations methods were used to account for correlations in a graft-level analysis. Kaplan-Meier estimates and Cox hazards regression were used to compare clinical outcomes. We similarly explored the association of the individual components CBVD and PVD with both VGF and clinical outcomes in an additive model.

Results

Patients with ECVD (n = 634, 21%) were older, more commonly female, and had more comorbidities, lower use of internal thoracic artery grafting, and overall worse graft quality than patients without ECVD. VGF rates tended to be higher (patient-level: odds ratio [OR]: 1.23, 95% confidence interval [CI] 0.96 to 1.58, p = 0.099; graft-level: OR: 1.23, 95% CI: 1.00 to 1.53, p = 0.053) in patients with ECVD. VGF rates were significantly higher among CBVD patients (OR: 1.42, 95% CI: 1.03 to 1.97, p = 0.035; graft-level: OR: 1.40, 95% CI: 1.06 to 1.85, p = 0.019). Patients with ECVD had a higher risk of death, myocardial infarction, or revascularization 5 years after CABG surgery (hazard ratio [HR]: 2.96, 95% CI: 2.02 to 4.35, p < 0.001). This relationship was driven by the subset of patients with PVD (HR = 3.32, 95% CI: 2.16 to 5.09, p < 0.001) and not by those with CBVD (HR = 1.10, 95% CI: 0.88 to 1.37, p = 0.40).

Conclusions

ECVD is common among patients undergoing CABG surgery and is associated with similar short-term but increasingly worse long-term clinical outcomes. This higher risk may be partly, but not exclusively, due to higher rates of VGF among these patients.

Section snippets

Study Population

We conducted a retrospective analysis using data from the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database. The design, primary results, and long-term follow-up have been published previously 2, 8, 9. In short, PREVENT IV was a phase 3, multicenter, randomized, double-blind, placebo-controlled trial of ex vivo treatment of vein grafts with the E2F transcription factor decoy edifoligide in patients undergoing CABG surgery. The trial enrolled 3,014

Demographic and Operative Characteristics

Baseline demographic and operative characteristics are described by ECVD status in Table 1. ECVD at baseline was identified in 634 (21.0%) of patients. Among patients with ECVD, 382 (60.3%) had CBVD, 369 (58.2%) had PVD, and 117 (18.5%) both. Patients with ECVD were older, more frequently female, and had a lower body mass index and more comorbidities. Marked differences in operative characteristics were also observed. Use of the internal thoracic artery as a bypass graft was significantly lower

Comment

In this study we investigated the association between ECVD and both vein graft patency and 5-year clinical outcomes after CABG surgery. We found that, compared with patients who did not have ECVD, patients with ECVD were older and had higher rates of comorbidities. These characteristics have probably influenced the intraoperative parameters as well, as suggested by lower use of internal thoracic artery grafting and poorer vein graft quality. After adjustment for these baseline differences, ECVD

References (19)

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