title: Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV.
abstract: BACKGROUND
  Coronary artery bypass grafting success is limited by vein graft failure (VGF). Understanding the factors associated with VGF may improve patient outcomes.
  
  
  RESULTS
  We examined 1828 participants in the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial undergoing protocol-mandated follow-up angiography 12 to 18 months post-coronary artery bypass grafting or earlier clinically driven angiography. Outcomes included patient- and graft-level angiographic VGF (≥75% stenosis or occlusion). Variables were selected by using Fast False Selection Rate methodology. We examined relationships between variables and VGF in patient- and graft-level models by using logistic regression without and with generalized estimating equations. At 12 to 18 months post-coronary artery bypass grafting, 782 of 1828 (42.8%) patients had VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and clinical characteristics were similar between patients with and without VGF, although VGF patients had longer surgical times, worse target artery quality, longer graft length, and they more frequently underwent endoscopic vein harvesting. After multivariable adjustment, longer surgical duration (odds ratio per 10-minute increase, 1.05; 95% confidence interval, 1.03-1.07), endoscopic vein harvesting (odds ratio, 1.41; 95% confidence interval, 1.16-1.71), poor target artery quality (odds ratio, 1.43; 95% confidence interval, 1.11-1.84), and postoperative use of clopidogrel or ticlopidine (odds ratio, 1.35; 95% confidence interval, 1.07-1.69) were associated with patient-level VGF. The predicted likelihood of VGF in the graft-level model ranged from 12.1% to 63.6%.
  
  
  CONCLUSIONS
  VGF is common and associated with patient and surgical factors. These findings may help identify patients with risk factors for VGF and inform the development of interventions to reduce VGF.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00042081.
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Connie N
authors.initials: CN
authors.lastname: Hess
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hager
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Wojdyla
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute, Duke Medicine, Durham, NC (C.N.H., R.D.L., R.H., D.M.W., B.R.E., E.D.P., J.H.A.); Harvard Medical School, Harvard University, Boston, MA (C.M.G.); Baylor Health Care System, Baylor, TX (M.J.M.); Duke Translational Medicine Institute, Duke Medicine, Durham, NC (R.M.C.); and Missouri Baptist Medical Center, St. Louis, MO (N.T.K.). john.h.alexander@duke.edu.
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012501:Saphenous Vein / Q000637:transplantation*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014654:Vascular Patency
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: coronary artery bypass; coronary disease; myocardial revascularization