Symptomatic early coronary graft failure in bypass surgery patients: incidence, predictors and clinical impact.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Netherlands Heart Journal Pub Date : 2025-01-20 DOI:10.1007/s12471-024-01926-z

Martijn J H van Oort, Ibtihal Al Amri, Arend de Weger, Madelien V Regeer, J Wouter Jukema, Bart J A Mertens, Jose M Montero-Cabezas

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Abstract

Objectives: Coronary graft failure (CGF) may occur early after coronary bypass graft surgery (CABG). The study aimed to identify clinical and perioperative risk factors and to evaluate the long-term clinical impact of symptomatic early CGF.

Methods: Patients who underwent clinically indicated coronary angiography (CAG) prior to post-CABG discharge between 2012 and 2022 were included. Symptomatic early CGF was defined as a dysfunctional coronary graft, evaluated on clinically indicated CAG, caused by stenosis of the proximal or distal anastomosis or bypass conduit, bypass occlusion, thrombosis, reduced flow (TIMI < 1) and kinking/tenting. Patients were divided into symptomatic early CGF and non-early CGF groups. Kaplan-Meier and multivariate analysis estimated cumulative survival free of major adverse cardiovascular events (MACE: death, myocardial infarction and revascularisation) up to 5 years' follow-up and identified predictors of symptomatic early CGF.

Results: A total of 92 patients (79% male, 66.1 ± 10 years old) were included, of whom 55 (59.8%) had symptomatic early CGF. Baseline characteristics, surgical parameters and post-surgical parameters potentially indicative of ischaemia were comparable between groups. Patients with symptomatic early CGF had a significantly lower MACE rate over a median follow-up period of 33 months (p = 0.023). Venous graft integration (p = 0.005), Y‑graft configuration (p = 0.002) and prolonged inotropic support (p = 0.032) were associated with symptomatic early CGF.

Conclusions: Symptomatic early CGF was observed in the majority of post-CABG patients undergoing clinically indicated CAG prior to discharge. Patients with symptomatic early CGF exhibited higher MACE rates over a median follow-up period of 33 months. Venous graft integration, Y‑graft configuration and prolonged use of inotropic agents were associated with symptomatic early CGF. However, these clinical findings should be interpreted with caution.

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搭桥手术患者的症状性早期冠状动脉移植失败：发生率、预测因素和临床影响。

目的：冠状动脉旁路移植术（CABG）后早期可能发生冠状动脉移植失败（CGF）。该研究旨在确定临床和围手术期危险因素，并评估症状性早期CGF的长期临床影响。方法：纳入2012年至2022年cabg术后出院前接受临床指征冠状动脉造影（CAG）的患者。症状性早期CGF定义为冠状动脉移植物功能不全，以临床指征CAG评价，由近端或远端吻合口狭窄或旁路导管狭窄、旁路闭塞、血栓形成、血流减少（TIMI）引起。结果：共纳入92例患者（79%男性，66.1 ±10岁），其中55例（59.8%）有症状性早期CGF。基线特征、手术参数和术后参数在两组间具有可比性。有症状的早期CGF患者在33个月的中位随访期间MACE率显著降低（p = 0.023）。静脉移植物整合（p = 0.005）、Y型移植物配置（p = 0.002）和延长肌力支持（p = 0.032）与早期症状性CGF相关。结论：大多数cabg后患者在出院前进行临床指征的CAG时观察到有症状的早期CGF。有症状的早期CGF患者在33个月的中位随访期间表现出更高的MACE率。静脉移植物整合、Y型移植物形态和长期使用肌力药物与早期症状性CGF相关。然而，这些临床发现应谨慎解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Netherlands Heart Journal CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.70

自引率

5.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The scope of the Netherlands Heart Journal is to contribute to the national and international literature by publishing scientific papers in the field of cardiovascular medicine. It also provides a platform for Continuing Medical Education for cardiologists and those in training for the speciality of cardiology in the Netherlands. The Netherlands Heart Journal is made available to cardiologists, cardiologists in training, cardiopulmonary surgeons, cardiopulmonary surgeons in training, internists and paediatric cardiologists. The journal is the official journal of the Netherlands Society of Cardiology.

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