Predictors of graft patency 3 years after coronary artery bypass graft surgery. Department of Veterans Affairs Cooperative Study Group No. 297.
OBJECTIVE
The purpose of this analysis was to define the factors that predict 3-year graft patency.


BACKGROUND
The success of coronary artery bypass graft surgery (CABG) is dependent on vein graft patency after the operation. It has been well established by a series of Department of Veterans Affairs Cooperative Trials that aspirin (325 mg daily) improves saphenous vein graft patency early (7 to 10 days) and at 1 year, but not at 3 years after CABG. This analysis, based on one of these trials, defined factors that predict 3-year graft patency.


METHODS
This analysis consisted of 266 patients, with 656 grafts that were patent 7 to 10 days after the operation, who underwent 3-year catheterization. To determine which patient-specific and/or graft-specific factors, or both, predict graft occlusion, a multivariate logistic regression analysis in terms of latent variables was used. It yielded a model that also took into account possible intraclass correlations.


RESULTS
For a vein graft that was patent at 7 to 10 days after the operation, the positive predictors, according to univariate analysis, for that graft being patent at 3 years were cross-clamp time < or = 80 min (p < 0.001), vein preservation solution temperature < or = 5 degrees C (p = 0.009), bypass time < or = 2 h (p = 0.042), number of proximal anastomoses < or = 2 (p = 0.018), operation time < or = 5 h (p = 0.044) and continuous versus intermittent cross-clamp technique (p = 0.024). There was also a trend with regard to recipient artery diameter > 1.5 mm (p = 0.063), serum cholesterol < or = 225 mg/dl (p = 0.084) and single versus sequential or Y vein graft (p = 0.060). Factors not predictive of 3-year patency were age, race, smoking history, high density lipoprotein cholesterol, vein source (thigh vs. calf), coronary artery grafted and aspirin treatment. Of all the predictors obtained in the univariate analysis, the only variables that were sufficient to yield a good model within the multivariate analysis were solution temperature (p = 0.004), serum cholesterol (p = 0.024), number of proximal anastomoses (p = 0.032) and recipient artery diameter (p = 0.034).


CONCLUSIONS
For a patient with patent vein grafts 7 to 10 days after the operation, predictors of 3-year graft patency are more closely related to operative techniques and underlying disease and not to aspirin treatment.
Goldman
S
S
Department of Veterans Affairs Medical Center and the University of Arizona Heart Center, Tucson 85723, USA.
Zadina
K
K
Krasnicka
B
B
Moritz
T
T
Sethi
G
G
Copeland
J
J
Ovitt
T
T
Henderson
W
W
D001026:Coronary Artery Bypass; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency