title: Saphenous vein graft failure and clinical outcomes: toward a surrogate end point in patients following coronary artery bypass surgery?
abstract: Saphenous vein graft (SVG) failure is a common finding in patients following coronary artery bypass graft (CABG) surgery. In the literature SVG failure rates have been reported from 25 to over 50% within 10 years. Although common, it remains unclear to what extent SVG failure affects clinical outcome, due to differences in definition, patient selection and follow-up. Particularly the lack of agreement on a universal definition makes comparisons between studies, and therefore generalizability of associations with outcomes, challenging. We suggest using a definition of SVG failure that is based on imaging as well as clinical parameters, that includes reporting SVG failure on both graft and patient level. The use of non-invasive imaging may help improve follow-up rates, and provide a more accurate picture of the real incidence and clinical impact of SVG failure. Given the lack of supportive evidence showing a consistent association between SVG failure and major adverse cardiovascular events, SVG failure should not be considered a valid surrogate endpoint at this time.
authors.forename: Ralf E
authors.initials: RE
authors.lastname: Harskamp
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Hill
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency