van Oort Martijn J H, Al Amri Ibtihal, de Weger Arend, Regeer Madelien V, Jukema J Wouter, Mertens Bart J A, Montero-Cabezas Jose M
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Thoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Neth Heart J. 2025 Mar;33(3):93-102. doi: 10.1007/s12471-024-01926-z. Epub 2025 Jan 20.
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.
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.
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.
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.
冠状动脉移植失败（CGF）可能在冠状动脉旁路移植术（CABG）后早期发生。本研究旨在确定临床和围手术期风险因素，并评估有症状的早期CGF的长期临床影响。
纳入2012年至2022年间在CABG术后出院前接受临床指征冠状动脉造影（CAG）的患者。有症状的早期CGF被定义为在临床指征的CAG上评估的功能失调的冠状动脉移植，其由近端或远端吻合口或旁路管道狭窄、旁路闭塞、血栓形成、血流减少（TIMI<1）和扭结/帐篷样改变引起。患者被分为有症状的早期CGF组和非早期CGF组。Kaplan-Meier和多变量分析估计了长达5年随访期内无主要不良心血管事件（MACE：死亡、心肌梗死和血运重建）的累积生存率，并确定了有症状的早期CGF的预测因素。
共纳入92例患者（79%为男性，年龄66.1±10岁），其中55例（59.8%）有症状的早期CGF。两组间可能提示缺血的基线特征、手术参数和术后参数具有可比性。在中位随访期33个月内，有症状的早期CGF患者的MACE发生率显著较低（p=0.023）。静脉移植物整合（p=0.005）、Y型移植物构型（p=0.002）和延长的正性肌力支持（p=0.032）与有症状的早期CGF相关。
在大多数出院前接受临床指征CAG的CABG术后患者中观察到有症状的早期CGF。在中位随访期33个月内，有症状的早期CGF患者的MACE发生率较高。静脉移植物整合、Y型移植物构型和延长使用正性肌力药物与有症状的早期CGF相关。然而，这些临床发现应谨慎解读。
