Document Detail


Impact of patient and target-vessel characteristics on arterial and venous bypass graft patency: insight from a randomized trial.
MedLine Citation:
PMID:  17283268     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this investigation was to determine optimal patient and target-vessel characteristics to maximize arterial and venous graft patency on the basis of data from a large clinical trial. METHODS AND RESULTS: Angiographic data on 440 radial artery grafts and 440 saphenous vein grafts were analyzed with methodology to account for within-patient clustering. Multivariable models that incorporated patient demographic, operative, anatomic, and postdischarge medical management were constructed to determine predictors of graft occlusion. Radial artery use was strongly protective against graft occlusion at 1 year after adjustment for all covariates, with a larger protective effect seen in women (P=0.05 for a subgroup-by-treatment interaction). Among all grafts, diabetes and small target-vessel diameter were associated with an increased risk of graft occlusion, and grafting to a target vessel with more severe proximal stenosis was associated with a decreased risk of graft occlusion. With regard to gender, radial artery graft occlusion at 1 year occurred in similar proportions of men (8.6%) and women (5.3%, P=0.6), whereas, for saphenous vein grafts the comparable occlusion rates were 12.0% and 23.3% respectively (P=0.02). A history of peripheral vascular disease was associated with an elevated risk of radial artery occlusion but was not associated with early vein graft occlusion (P=0.02 for a subgroup-by-treatment interaction). CONCLUSIONS: Patients benefit from radial artery-coronary artery bypass conduits as opposed to saphenous vein conduits, and this effect is especially strong in women. Small target-vessel size adversely affected graft patency, and grafting to a target vessel with more severe proximal stenosis improved graft patency.
Authors:
Nimesh D Desai; C David Naylor; Alexander Kiss; Eric A Cohen; Randi Feder-Elituv; Senri Miwa; Sam Radhakrishnan; James Dubbin; Leonard Schwartz; Stephen E Fremes;
Related Documents :
16401538 - Perivascular treatment with azathioprine reduces neointimal hyperplasia in experimental...
11340268 - Natural course of the functional and morphological changes in canine autogenous arteria...
11790578 - False aneurysm of the peroneal artery: an unusual complication of femoro-peroneal bypas...
19524728 - Tissue-engineered arterial grafts: long-term results after implantation in a small anim...
19610578 - Uncorrected tetralogy of fallot with agenesis of the left pulmonary artery in a 70-year...
16928558 - Successful reoperation after 17 years in a case of endomyocardial fibrosis.
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-02-05
Journal Detail:
Title:  Circulation     Volume:  115     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-13     Completed Date:  2007-03-12     Revised Date:  2007-11-13    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  684-91     Citation Subset:  AIM; IM    
Affiliation:
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. nimesh.desai@utoronto.ca
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography
Coronary Artery Bypass / methods*
Diabetes Complications / physiopathology
Female
Humans
Logistic Models
Male
Middle Aged
Peripheral Vascular Diseases / physiopathology
Radial Artery / transplantation*
Saphenous Vein / transplantation*
Sex Characteristics
Vascular Patency*
Comments/Corrections
Comment In:
Circulation. 2007 Feb 13;115(6):678-80   [PMID:  17296866 ]
Circulation. 2007 Oct 9;116(15):e374; author reply e375   [PMID:  17923580 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Risk index for perioperative renal dysfunction/failure: critical dependence on pulse pressure hypert...
Next Document:  Critical role of monocyte chemoattractant protein-1/CC chemokine ligand 2 in the pathogenesis of isc...