Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study,The Journal of Thoracic and Cardiovascular Surgery

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Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study
The Journal of Thoracic and Cardiovascular Surgery ( IF 6 ) Pub Date : 2022-06-02 , DOI: 10.1016/j.jtcvs.2022.05.028
Mariam Alboom ₁ , Austin Browne ₂ , Tej Sheth ₃ , Zhe Zheng ₄ , François Dagenais ₅ , Nicolas Noiseux ₆ , Miroslav Brtko ₇ , Louis-Mathieu Stevens ₆ , Shun Fu Lee ₈ , Ingrid Copland ₉ , Patricia Power ₂ , John Eikelboom ₃ , André Lamy ₁₀

Affiliation

Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Research, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China.
Department of Cardiac Surgery, Quebec Heart and Lung Institute affiliated with Laval University, Quebec City, Quebec, Canada.
Department of Cardiac Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
Department of Cardiac Surgery, Fakultní nemocnice Hradec Králové, Hradec Králové, Královéhradecký, Czech Republic.
Department of Statistics, Population Health Research Institute, Hamilton, Ontario, Canada.
Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.
Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.

Objectives

Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery.

Methods

A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery.

Results

Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P = .008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P = .001, respectively).

Conclusions

In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.

中文翻译：

冠状动脉搭桥手术中的导管选择和早期移植失败：使用抗凝策略 (COMPASS) 冠状动脉搭桥术研究的心血管结果的事后分析

目标

冠状动脉旁路移植术（CABG）手术中早期移植失败的相对率和导管选择仍然存在争议。因此，我们试图确定CABG 术后 1 年左内乳动脉(LIMA)、桡动脉、隐静脉和右内乳动脉 (RIMA) 移植失败的发生率和决定因素。

方法

对使用抗凝策略 (COMPASS) CABG 研究的心血管结果进行事后分析，涉及来自 22 个国家 83 个中心的患者。我们完成了对来自 1068 名接受 CABG 手术的患者的 3480 个移植物的分析，并具有完整的计算机断层扫描血管造影数据。主要结局是术后 1 年通过计算机断层扫描血管造影诊断的移植失败。

结果

LIMA 移植失败率为 6.4% (68/1068)，桡动脉移植失败率为 9.9% (9/91)，隐静脉移植失败率为 10.4% (232/2239)，RIMA 移植失败率为 26.8% (22/82)。RIMA 的移植失败率 (26.8%) 高于桡动脉 (9.9%) 和静脉 (10.4%)（调整后优势比，2.69；95% 置信区间，1.30-5.57；P = 0.008，调整后优势比，2.07；95% 置信区间，1.33-3.21；P = .001，分别）。