title: Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV trial.
abstract: BACKGROUND
  Limited information exists on the intermediate-term graft patency and 5-year clinical outcomes of patients receiving saphenous vein grafts with multiple (m-SVG) versus single distal targets (s-SVG) during coronary artery bypass graft (CABG) surgery in the current era.
  
  
  RESULTS
  We studied the association of the use of m-SVG versus s-SVG conduits with 1-year SVG failure (defined as ≥75% angiographic stenosis) and 5-year clinical events (death; death or myocardial infarction [MI]; and death, MI, or revascularization) in 3014 patients undergoing their first CABG surgery enrolled in the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV. Of 3014 patients enrolled in PREVENT IV, 1045 (34.7%) had ≥1 m-SVGs during CABG. Vein graft failure at 1-year was higher for m-SVG compared with s-SVG (adjusted odds ratio 1.24, 95% confidence interval 1.03 to 1.48). At 5 years, the adjusted composite of death, MI (including perioperative MI), or revascularization (hazard ratio 1.15, 95% confidence interval 1.00 to 1.31) and death or MI (hazard ratio 1.21, 95% confidence interval 1.03 to 1.43) were significantly higher in patients receiving m-SVGs.
  
  
  CONCLUSIONS
  In patients undergoing first CABG surgery, the use of m-SVG was associated with a higher 1-year vein graft failure rate and trends toward worse clinical outcomes. Additional studies are needed to better understand the most appropriate conduit to improve long-term graft patency and clinical outcomes of patients undergoing CABG surgery. In the meantime, these data should encourage the use of s-SVG over m-SVG when feasible.
authors.affiliation: Duke Clinical Research Institute, Box 17969, Durham, NC 27715, USA. mehta007@dcri.duke.edu
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Gail E
authors.initials: GE
authors.lastname: Hafley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001807:Blood Vessel Prosthesis; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000502:physiology / Q000601:surgery*; D014162:Transfection; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology