title: Relationship between vein graft failure and subsequent clinical outcomes after coronary artery bypass surgery.
abstract: BACKGROUND
  Vein graft failure (VGF) is common after coronary artery bypass graft surgery, but its relationship with long-term clinical outcomes is unknown. In this retrospective analysis, we examined the relationship between VGF, assessed by coronary angiography 12 to 18 months after coronary artery bypass graft surgery, and subsequent clinical outcomes.
  
  
  RESULTS
  Using the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database, we studied data from 1829 patients who underwent coronary artery bypass graft surgery and had an angiogram performed up to 18 months after surgery. The main outcome measure was death, myocardial infarction, and repeat revascularization through 4 years after angiography. VGF occurred in 787 of 1829 patients (43%). Clinical follow-up was completed in 97% of patients with angiographic follow-up. The composite of death, myocardial infarction, or revascularization occurred more frequently among patients who had any VGF compared with those who had none (adjusted hazard ratio, 1.58; 95% confidence interval, 1.21-2.06; P=0.008). This was due mainly to more frequent revascularization with no differences in death (adjusted hazard ratio, 1.04; 95% confidence interval, 0.71-1.52; P=0.85) or death or myocardial infarction (adjusted hazard ratio, 1.08; 95% confidence interval, 0.77-1.53; P=0.65).
  
  
  CONCLUSIONS
  VGF is common after coronary artery bypass graft surgery and is associated with repeat revascularization but not with death and/or myocardial infarction. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing coronary artery bypass graft surgery.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, DUMC Box 3850, Durham, NC 27705, USA.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Gail E
authors.initials: GE
authors.lastname: Hafley
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Keith B
authors.initials: KB
authors.lastname: Allen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
mesh_terms: D000368:Aged; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome; D014654:Vascular Patency