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Graft Failure After Coronary Artery Bypass Grafting and Its Association With Patient Characteristics and Clinical Events: A Pooled Individual Patient Data Analysis of Clinical Trials With Imaging Follow-Up.
Gaudino, Mario; Sandner, Sigrid; An, Kevin R; Dimagli, Arnaldo; Di Franco, Antonino; Audisio, Katia; Harik, Lamia; Perezgrovas-Olaria, Roberto; Soletti, Giovanni; Fremes, Stephen E; Hare, David L; Kulik, Alexander; Lamy, Andre; Peper, Joyce; Ruel, Marc; Ten Berg, Jurrien M; Willemsen, Laura M; Zhao, Qiang; Wojdyla, Daniel M; Bhatt, Deepak L; Alexander, John H; Redfors, Bjorn.
Afiliação
  • Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Sandner S; Department of Cardiac Surgery, Medical University of Vienna, Austria (S.S.).
  • An KR; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Dimagli A; Division of Cardiac Surgery (K.R.A.), University of Toronto, Canada.
  • Di Franco A; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Audisio K; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Harik L; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Perezgrovas-Olaria R; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Soletti G; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Fremes SE; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., K.R.A., A.D., A.D.F., K.A., L.H., R. P.-O., G.S.).
  • Hare DL; Department of Cardiac Surgery, Schulich Heart Centre Sunnybrook Health Sciences Centre (S.E.F.), University of Toronto, Canada.
  • Kulik A; Department of Cardiology, Austin Health, University of Melbourne, Australia (D.L.H.).
  • Lamy A; Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic Hospital (A.K.).
  • Peper J; Department of Surgery, McMaster University, Hamilton, Canada (A.L.).
  • Ruel M; Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.P., J.M.t.B., L.M.W.).
  • Ten Berg JM; Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada (M.R.).
  • Willemsen LM; Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.P., J.M.t.B., L.M.W.).
  • Zhao Q; Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.P., J.M.t.B., L.M.W.).
  • Wojdyla DM; Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (Q.Z.).
  • Bhatt DL; Duke Clinical Research Institute (D.M.W.), Duke University Medical Center, Durham, NC.
  • Alexander JH; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (D.L.B.).
  • Redfors B; Division of Cardiology, Department of Medicine (J.H.A.), Duke University Medical Center, Durham, NC.
Circulation ; 148(17): 1305-1315, 2023 Oct 24.
Article em En | MEDLINE | ID: mdl-37417248
ABSTRACT

BACKGROUND:

Graft patency is the postulated mechanism for the benefits of coronary artery bypass grafting (CABG). However, systematic graft imaging assessment after CABG is rare, and there is a lack of contemporary data on the factors associated with graft failure and on the association between graft failure and clinical events after CABG.

METHODS:

We pooled individual patient data from randomized clinical trials with systematic CABG graft imaging to assess the incidence of graft failure and its association with clinical risk factors. The primary outcome was the composite of myocardial infarction or repeat revascularization occurring after CABG and before imaging. A 2-stage meta-analytic approach was used to evaluate the association between graft failure and the primary outcome. We also assessed the association between graft failure and myocardial infarction, repeat revascularization, or all-cause death occurring after imaging.

RESULTS:

Seven trials were included comprising 4413 patients (mean age, 64.4±9.1 years; 777 [17.6%] women; 3636 [82.4%] men) and 13 163 grafts (8740 saphenous vein grafts and 4423 arterial grafts). The median time to imaging was 1.02 years (interquartile range [IQR], 1.00-1.03). Graft failure occurred in 1487 (33.7%) patients and in 2190 (16.6%) grafts. Age (adjusted odds ratio [aOR], 1.08 [per 10-year increment] [95% CI, 1.01-1.15]; P=0.03), female sex (aOR, 1.27 [95% CI, 1.08-1.50]; P=0.004), and smoking (aOR, 1.20 [95% CI, 1.04-1.38]; P=0.01) were independently associated with graft failure, whereas statins were associated with a protective effect (aOR, 0.74 [95% CI, 0.63-0.88]; P<0.001). Graft failure was associated with an increased risk of myocardial infarction or repeat revascularization occurring between CABG and imaging assessment (8.0% in patients with graft failure versus 1.7% in patients without graft failure; aOR, 3.98 [95% CI, 3.54-4.47]; P<0.001). Graft failure was also associated with an increased risk of myocardial infarction or repeat revascularization occurring after imaging (7.8% versus 2.0%; aOR, 2.59 [95% CI, 1.86-3.62]; P<0.001). All-cause death after imaging occurred more frequently in patients with graft failure compared with patients without graft failure (11.0% versus 2.1%; aOR, 2.79 [95% CI, 2.01-3.89]; P<0.001).

CONCLUSIONS:

In contemporary practice, graft failure remains common among patients undergoing CABG and is strongly associated with adverse cardiac events.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Risk_factors_studies Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Risk_factors_studies Idioma: En Ano de publicação: 2023 Tipo de documento: Article