Unanswered questions on coronary artery graft patency and clinical outcomes.

Purpose of review: To review current issues related to coronary artery graft patency and outcomes.

Recent findings: The association of coronary artery graft patency with clinical outcomes is a traditional concept; however, it has been challenged by the results of numerous studies. Key limitations of the existing evidence include the lack of a universal definition of graft failure, the absence of systematic imaging in contemporary coronary artery bypass grafting trials, the reliance on observational data with inherent selection and survival bias, and high attrition rates for follow-up imaging. Key modulators of graft failure, and of the relationship between graft failure and outcomes, include the type of conduit and myocardial territory grafted, conduit harvesting technique, and postoperative antithrombotic regimen and patient sex.

Summary: The relationship between graft failure and clinical events is complex and variable. Overall, the preponderance of current data suggests a possible association between graft failure and nonfatal clinical events.