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Angiographic Outcome of Coronary Artery Bypass Grafts: The Radial Artery Database International Alliance

 Mario Gaudino  ;  Umberto Benedetto  ;  Stephen E Fremes  ;  David L Hare  ;  Philip Hayward  ;  Neil Moat  ;  Marco Moscarelli  ;  Antonino Di Franco  ;  Giuseppe Nasso  ;  Miodrag Peric  ;  Ivana Petrovic  ;  Peter Collins  ;  Carolyn M Webb  ;  John D Puskas  ;  Giuseppe Speziale  ;  Kyung Jong Yoo  ;  Leonard N Girardi  ;  David P Taggart 
 ANNALS OF THORACIC SURGERY, Vol.109(3) : 688-694, 2020-03 
Journal Title
Issue Date
Aged ; Coronary Angiography* ; Coronary Artery Bypass* / methods ; Databases, Factual ; Female ; Graft Occlusion, Vascular / epidemiology* ; Humans ; Incidence ; Internal Mammary-Coronary Artery Anastomosis ; Male ; Mammary Arteries / transplantation ; Middle Aged ; Radial Artery / transplantation ; Randomized Controlled Trials as Topic ; Risk Factors ; Saphenous Vein / transplantation ; Stroke Volume ; Treatment Failure ; Vascular Patency
Background. We used a large patient-level data set including 6 angiographic randomized controlled trials (RCTs) on coronary artery bypass conduits to explore incidence and determinants of coronary graft failure. Methods. Patient-level angiographic data of 6 RCTs comparing long-term outcomes of the radial artery and other conduits were joined. Primary outcome was graft occlusion at maximum follow-up. The analysis was divided as (1) left anterior descending coronary (LAD) distribution and (2) non-LAD distribution (circumflex and right coronary artery). Mixed-model multivariable Cox regression including all baseline characteristics with stratification by individual trials was used to identify predictors of graft occlusion. Results. Included were 1091 patients and 2281 grafts, consisting of 921 left internal mammary arteries, 74 right internal mammary arteries, 710 radial arteries, and 576 saphenous veins. All left internal mammary arteries were used on the LAD, the other conduits were used on the non-LAD distribution. Mean angiographic follow up was 65 +/- 29 months. Occlusion rates were 2.3% for the left internal mammary arteries, 13.5% for the left internal mammary arteries, 9.4% for the right internal mammary arteries, and 17.5% for the saphenous veins. At multivariable analysis, type of conduit used, age, female sex, left ventricular ejection fraction of less than 0.50, and use of the Y graft were significantly associated with graft occlusion in the non-LAD distribution. Conclusions. Our analyses showed that failure of the left internal mammary arteries-to-LAD bypass is a very uncommon event. For the non-LAD distribution, the nonuse of radial artery, age, female sex, left ventricular ejection fraction of less than 0.50, and use of the Y graft configuration were significantly associated with midterm graft failure.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
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