Fate of Grafts Bypassing Nonischemic Versus Ischemic Inducing Coronary Stenosis
- Authors
- Roh, Jae-Hyung; Kim, Young-Hak; Yang, Dong Hyun; Han, Seungbong; Yun, Sung-Cheol; Yang, Dong Heon; Park, Gyung-Min; Lee, Pil Hyung; Ahn, Jung-Min; Kang, Joon-Won; Lim, Tae-Hwan; Moon, Dae Hyuk; Kim, Joon Bum; Jung, Sung-Ho; Chung, Cheol Hyun; Choo, Suk Jung; Lee, Jae Won; Kang, Soo-Jin; Park, Duk-Woo; Lee, Seung-Whan; Lee, Cheol Whan; Park, Seong-Wook; Park, Seung-Jung
- Issue Date
- 1-Oct-2018
- Publisher
- EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
- Citation
- AMERICAN JOURNAL OF CARDIOLOGY, v.122, no.7, pp.1148 - 1154
- Journal Title
- AMERICAN JOURNAL OF CARDIOLOGY
- Volume
- 122
- Number
- 7
- Start Page
- 1148
- End Page
- 1154
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/3226
- DOI
- 10.1016/j.amjcard.2018.06.028
- ISSN
- 0002-9149
- Abstract
- There is a lack of evidence regarding the efficacy of ischemia-guided coronary artery bypass grafting. We compared the incidence of graft failure between grafts bypassing ischemia-inducing and nonischemia-inducing stenoses. Between 1997 and 2011, 2,304 patients for whom baseline coronary angiography and myocardial perfusion imaging were available were identified from a single-center coronary artery bypass grafting registry. According to baseline myocardial perfusion imaging, each graft was assigned to either graft bypassing ischemia-inducing or nonischemia-inducing stenoses (ischemia-related grafts, n = 4,904; ischemia-unrelated grafts, n = 2,709). Graft failure was defined as total occlusion on coronary computed tomography angiography, performed at the discretion of the treating physician. The incidence of graft failure was compared on a per-graft basis. At 5 years, the incidence of graft failure was significantly higher in the ischemia-unrelated grafts (4.2% vs 2.9% in ischemia-related grafts; p = 0.003). Ischemia-related graft was an independent determinant of graft patency (adjusted hazard ratio 0.61; 95% confidence interval 0.44 to 0.84; p = 0.002). Increased risk of graft failure associated with ischemia-unrelated graft was observed only in the internal thoracic artery (3.3% vs 2.0%, p = 0.021) and arterial grafts (6.5% vs 4.3%, p = 0.020), but not in the venous grafts (2.7% vs 2.7%; p = 0.99). In terms of major adverse cardiac and cerebrovascular events, 5-year incidences were comparable between the patients with and without ischemia-unrelated grafts (219, 19.3% vs 160, 18.0%; p = 0.61). In conclusion, ischemia-unrelated grafts became dysfunctional more frequently than ischemia-related grafts, and were not preventive of adverse events. (C) 2018 Elsevier Inc. All rights reserved.
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