Risk of New Native-Vessel Occlusion After Coronary Artery Bypass Grafting.
Coronary computed tomography angiography is widely used to evaluate the graft patency, but information on the progression of native-vessel disease remains limited. We sought to evaluate the impact of bypass grafting on native-vessel progression after coronary artery bypass grafting. We evaluated new native-vessel occlusion defined as occlusion length ≥15 mm as a surrogate marker of native-vessel progression. We evaluated 911 patients with 2,271 nonoccluded vessels who underwent coronary artery bypass grafting and received follow-up coronary computed tomography angiography. Over a mean follow-up period of 4.7 years, the new occlusion rates were 9.2% for left anterior descending artery (LAD), and 13.9% for non-LAD, respectively. For non-LAD, new occlusion rate of vessels with bypass grafts was higher compared to those without bypass graft regardless of baseline native-vessel stenosis (intermediate stenosis: 8.6% vs 1.7%, p <0.001; severe stenosis: 20.5% vs 9.9%, p = 0.003). Furthermore, new occlusion rate of vessels with venous graft was the highest, followed by vessels with arterial graft and vessels without bypass graft, regardless of baseline stenosis (intermediate stenosis: 11.1% vs 5.2% vs 1.7%, p <0.001; severe stenosis: 23.7% vs 15.9% vs 9.9%, p <0.001). By multivariate analysis, bypass grafting was associated with new native-vessel occlusion for non-LAD (odds ratio 3.04, 95% confidence interval 1.79 to 5.14; p <0.001). Bypass graft was associated with new native-vessel disease progression regardless of baseline stenosis. In conclusion, the decision to bypass or leave a native vessel with intermediate stenosis should cautiously be considered.
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung-Han
SH
Yoon
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: mdyhkim@amc.seoul.kr.
Young-Hak
YH
Kim
Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dong Hyun
DH
Yang
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jae-Hyung
JH
Roh
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Eun Young
EY
Lee
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Pil Hyung
PH
Lee
Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan.
Daisuke
D
Sugiyama
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Mineok
M
Chang
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jung-Min
JM
Ahn
Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Won Jin
WJ
Choi
Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Joon-Won
JW
Kang
Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Tae-Hwan
TH
Lim
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Joon Bum
JB
Kim
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung-Ho
SH
Jung
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Cheol Hyun
CH
Chung
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Suk Jung
SJ
Choo
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jae Won
JW
Lee
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Soo-Jin
SJ
Kang
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Duk-Woo
DW
Park
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seung-Whan
SW
Lee
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Cheol Whan
CW
Lee
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seong-Wook
SW
Park
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seung-Jung
SJ
Park
D000072226:Computed Tomography Angiography; D003287:Contrast Media; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014654:Vascular Patency
D003287:Contrast Media