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Saphenous Vein Grafts With Multiple Versus Single Distal Targets in Patients Undergoing Coronary Artery Bypass Surgery: One-Year Graft Failure and Five-Year Outcomes From the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial
Study Questions:
What are the differences in the patency of single proximal and multiple distal anastomoses (m-SVG) versus single proximal and distal anastomoses (s-SVG) conduits at 1 year, and the differences in 5-year outcomes of patients receiving m-SVG compared with those receiving only s-SVG during coronary artery bypass graft (CABG) surgery?
Methods:
The investigators studied the association of the use of m-SVG versus s-SVG conduits with 1-year SVG failure (defined as ≥75% angiographic stenosis) and 5-year clinical events (death; death or myocardial infarction [MI]; and death, MI, or revascularization) in 3,014 patients undergoing their first CABG surgery enrolled in the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial. The main clinical endpoint for this analysis was the composite of death, MI, or repeat revascularization at 5 years. The statistical significance of differences in outcomes between the two groups was assessed with the log-rank test.
Results:
Of 3,014 patients enrolled in PREVENT IV, 1,045 (34.7%) had ≥1 m-SVGs during CABG. Vein graft failure at 1 year was higher for m-SVG compared with s-SVG (adjusted odds ratio, 1.24; 95% confidence interval [CI], 1.03-1.48). At 5 years, the adjusted composite of death, MI (including perioperative MI), or revascularization (hazard ratio, 1.15; 95% CI, 1.00-1.31) and death or MI (hazard ratio, 1.21; 95% CI, 1.03-1.43) were significantly higher in patients receiving m-SVGs.
Conclusions:
The authors concluded that among patients undergoing first CABG surgery, the use of m-SVG was associated with a higher 1-year vein graft failure rate and trends toward worse clinical outcomes.
Perspective:
This study suggests that compared with s-SVG conduits, the use of m-SVG conduits was associated with a higher rate of 1-year vein graft failure in patients undergoing first CABG. The 5-year composite of death, MI, or revascularization also tended to be higher in patients receiving m-SVG. These findings should spur further research to identify why m-SVGs have a higher failure rate and to better understand the most appropriate conduit to improve long-term graft patency and clinical outcomes of patients undergoing CABG surgery. In the meantime, the use of arterial conduits and s-SVG over m-SVG should be encouraged whenever clinically feasible.
Keywords: Odds Ratio, Myocardial Infarction, Transplants, Saphenous Vein, Constriction, Pathologic, Confidence Intervals, Transfection, Coronary Artery Bypass
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