Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes

Ralf E. Harskamp, John H. Alexander, T. Bruce Ferguson, Rebecca Hager, Michael J. MacK, Brian Englum, Daniel Wojdyla, Phillip Schulte, Nicholas T. Kouchoukos, Robbert J. De Winter, C. Michael Gibson, Eric D. Peterson, Robert A. Harrington, Peter K. Smith, Renato D. Lopes

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background - The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. Methods and Results - The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio, 1.76; 95% confidence interval, 1.19-2.59), additional bypass graft to diagonal branch (odds ratio, 1.92; 95% confidence interval, 1.33-2.76), and not having diabetes mellitus (odds ratio, 1.82; 95% confidence interval, 1.20-2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly as a result of a higher rate of repeat revascularization. Conclusions - IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns about competitive flow and the benefit of coronary artery bypass grafting in intermediate LAD stenosis without functional evidence of ischemia.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalCirculation
Volume133
Issue number2
DOIs
StatePublished - Jan 12 2016
Externally publishedYes

Fingerprint

Mammary Arteries
Transplants
Pathologic Constriction
Odds Ratio
Confidence Intervals
Coronary Artery Bypass
Angiography
Transfection
Veins
Diabetes Mellitus
Ischemia
Arteries
Logistic Models
Myocardial Infarction

Keywords

  • coronary artery bypass
  • mammary arteries

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Harskamp, R. E., Alexander, J. H., Ferguson, T. B., Hager, R., MacK, M. J., Englum, B., ... Lopes, R. D. (2016). Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes. Circulation, 133(2), 131-138. https://doi.org/10.1161/CIRCULATIONAHA.115.015549

Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes. / Harskamp, Ralf E.; Alexander, John H.; Ferguson, T. Bruce; Hager, Rebecca; MacK, Michael J.; Englum, Brian; Wojdyla, Daniel; Schulte, Phillip; Kouchoukos, Nicholas T.; De Winter, Robbert J.; Gibson, C. Michael; Peterson, Eric D.; Harrington, Robert A.; Smith, Peter K.; Lopes, Renato D.

In: Circulation, Vol. 133, No. 2, 12.01.2016, p. 131-138.

Research output: Contribution to journalArticle

Harskamp, RE, Alexander, JH, Ferguson, TB, Hager, R, MacK, MJ, Englum, B, Wojdyla, D, Schulte, P, Kouchoukos, NT, De Winter, RJ, Gibson, CM, Peterson, ED, Harrington, RA, Smith, PK & Lopes, RD 2016, 'Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes', Circulation, vol. 133, no. 2, pp. 131-138. https://doi.org/10.1161/CIRCULATIONAHA.115.015549
Harskamp RE, Alexander JH, Ferguson TB, Hager R, MacK MJ, Englum B et al. Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes. Circulation. 2016 Jan 12;133(2):131-138. https://doi.org/10.1161/CIRCULATIONAHA.115.015549
Harskamp, Ralf E. ; Alexander, John H. ; Ferguson, T. Bruce ; Hager, Rebecca ; MacK, Michael J. ; Englum, Brian ; Wojdyla, Daniel ; Schulte, Phillip ; Kouchoukos, Nicholas T. ; De Winter, Robbert J. ; Gibson, C. Michael ; Peterson, Eric D. ; Harrington, Robert A. ; Smith, Peter K. ; Lopes, Renato D. / Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes. In: Circulation. 2016 ; Vol. 133, No. 2. pp. 131-138.
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abstract = "Background - The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. Methods and Results - The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75{\%} stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6{\%}). Predictors of IMA graft failure were LAD stenosis <75{\%} (odds ratio, 1.76; 95{\%} confidence interval, 1.19-2.59), additional bypass graft to diagonal branch (odds ratio, 1.92; 95{\%} confidence interval, 1.33-2.76), and not having diabetes mellitus (odds ratio, 1.82; 95{\%} confidence interval, 1.20-2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly as a result of a higher rate of repeat revascularization. Conclusions - IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns about competitive flow and the benefit of coronary artery bypass grafting in intermediate LAD stenosis without functional evidence of ischemia.",
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AU - Harskamp, Ralf E.

AU - Alexander, John H.

AU - Ferguson, T. Bruce

AU - Hager, Rebecca

AU - MacK, Michael J.

AU - Englum, Brian

AU - Wojdyla, Daniel

AU - Schulte, Phillip

AU - Kouchoukos, Nicholas T.

AU - De Winter, Robbert J.

AU - Gibson, C. Michael

AU - Peterson, Eric D.

AU - Harrington, Robert A.

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AU - Lopes, Renato D.

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N2 - Background - The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. Methods and Results - The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio, 1.76; 95% confidence interval, 1.19-2.59), additional bypass graft to diagonal branch (odds ratio, 1.92; 95% confidence interval, 1.33-2.76), and not having diabetes mellitus (odds ratio, 1.82; 95% confidence interval, 1.20-2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly as a result of a higher rate of repeat revascularization. Conclusions - IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns about competitive flow and the benefit of coronary artery bypass grafting in intermediate LAD stenosis without functional evidence of ischemia.

AB - Background - The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. Methods and Results - The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio, 1.76; 95% confidence interval, 1.19-2.59), additional bypass graft to diagonal branch (odds ratio, 1.92; 95% confidence interval, 1.33-2.76), and not having diabetes mellitus (odds ratio, 1.82; 95% confidence interval, 1.20-2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly as a result of a higher rate of repeat revascularization. Conclusions - IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns about competitive flow and the benefit of coronary artery bypass grafting in intermediate LAD stenosis without functional evidence of ischemia.

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