title: Correlates of saphenous vein graft hyperplasia and occlusion 1 year after coronary artery bypass grafting: analysis from the CASCADE randomized trial.
abstract: BACKGROUND
  Intimal hyperplasia of saphenous vein grafts (SVGs) can lead to subsequent graft atherosclerosis and occlusion after coronary artery bypass grafting (CABG). This study examined whether patient characteristics, anatomic factors, and medications are associated with SVG intimal hyperplasia and occlusion after CABG.
  
  
  RESULTS
  We performed a post hoc analysis of the Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) trial, where 322 grafts were assessed by angiography and 90 grafts were examined by intravascular ultrasound at 1 year after CABG. We assessed the following correlates for intimal hyperplasia and occlusion: patient characteristics, discharge medications, target vessel characteristics, and SVG diameter. At 1 year, the SVG mean intimal area was 4.3 ± 2.1 mm(2), and the occlusion rate was 6.2% (13/209). Independent correlates of hyperplasia were larger SVG diameter (1.9 ± 0.2 mm(2)/mm; P<0.001), hypertension (0.7 ± 0.3 mm(2); P=0.03), and grafting to the right coronary territory (0.6 ± 0.3 mm(2); P=0.03), whereas statin (-0.8 ± 0.3 mm(2); P=0.01) and β-blocker use (-1.0 ± 0.4 mm(2); P=0.03) were associated with less hyperplasia. Low target vessel quality was an independent correlate of SVG occlusion (odds ratio, 5.2 ± 3.1; P<0.01).
  
  
  CONCLUSIONS
  Hypertension, SVG diameter, grafting to the right coronary artery, and low quality of the target vessel correlate with the development of SVG hyperplasia or occlusion by 1 year after CABG, whereas β-blockers and statins are associated with less SVG disease. These new findings further our understanding of SVG remodeling after bypass surgery and may guide future research to help prevent post-CABG SVG disease.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00228423.
authors.affiliation: Divisions of Cardiac Surgery and Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.U., M.L. M.R.); Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Boca Raton, FL (A.K.); and Department of Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.).
authors.forename: Dai
authors.initials: D
authors.lastname: Une
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: Michel
authors.initials: M
authors.lastname: Le May
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000639:trends; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000473:pathology* / Q000601:surgery*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine
keywords: coronary artery bypass surgery; hyperplasia; saphenous vein; β-blockers, adrenergic