The Effect of Cardiovascular Risk Factors and Coronary Atherosclerosis Severity on Long Term Graft Patency Rate in Patients Who Underwent Coronary Artery Bypass Graft Surgery
1Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
2Department of Cardiology, Liv Hospital, Istanbul, Turkey
3Department of Cardiology, Florence Nightingale Hospital, Istanbul, Turkey
4Department of Cardiology, Kastamonu Training and Research Hospital, Istanbul, Turkey
5Department of Cardiology, Koc University Hospital, Istanbul, Turkey
Keywords: Coronary artery disease; heart disease risk factors; coronary artery bypass grafting.
Introduction: The postoperative success of coronary artery bypass grafting depends on graft patency rate. The atherosclerotic process goes on in native arteries and bypass grafts of patients who underwent coronary artery bypass graft surgery. In this study, we aimed to investigate the effect of preoperative cardiovascular risk factors and the extensity of atherosclerosis detected by coronary angiography on long-term graft survival after the operation.
Patients and Methods: We included 974 patients (738 males, 236 females, mean age 57.9 ± 9.0 years) who underwent isolated coronary artery bypass graft surgery between the years 1990-2010 and coronary angiography due to various reasons during their follow-ups. The cardiovascular risk factors of the patients were detected and the extensity of coronary artery disease in the pre-operative coronary angiographies was determined by calculating Gensini Score Index. The effect of these results on graft patency was analyzed.
Results: As a result of coronary angiography, overall graft patency rates were found to be 52.6%, 64.6%, and 38.4% in the 1st, 5th and 10th years, respectively. Arterial grafts showed better patency rates than venous grafts in both short-term (1st year) and long-term (5th and 10th years). Independent cardiovascular risk factors were age (beta: 0.006, p= 0.001), smoking (beta: 0.101, p= 0.003), and family history (beta: 0.063, p= 0.03) for all occluded grafts. Diabetes mellitus (beta: 0.03, p= 0.02) and Gensini Score Index (beta: 0.01, p= 0.03) were associated with occluded left internal mammary artery graft. Age (beta: 0.05, p= 0.002), smoking (beta: 0.073, p= 0.002), and Gensini Score Index (beta: 0.001, p= 0.002) were associated with occluded saphenous vein graft. Smoking (beta: 0.047, p= 0.001), family history (beta: 0.033, p= 0.013), and Gensini Score Index (beta: 0.001, p= 0.001) were associated with occluded right internal mammary artery graft.
Conclusion: According to short and long-term results of a large group of patients, graft atherosclerosis was associated with cardiovascular risk factors, the extensity of coronary atherosclerosis, type and duration of graft. Today, primary and secondary cardiovascular risk factors should be improved to achieve higher longterm graft patency rates.
This study was approved by the Scientific Research and Evaluation Committee of Istanbul Bilim University Faculty of Medicine (Decision No: 24.12.2010/1).
Informed consent was obtained.
Concept/Design - KS; Analysis/Interpretation - YT; Data Collection - KS, BD; Writing - KS; Critical Revision - ÇÇ, NY; Statistical Analysis - YT, SY; Overall Responsibility - KS; Final Approval - All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.