Graft patency and progression of coronary artery disease after CABG assessed by angiography-derived fractional flow reserve.
Angiography-derived FFR
CABG
Competitive flow
FFR
Graft occlusion
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 10 2020
01 10 2020
Historique:
received:
28
11
2019
revised:
15
04
2020
accepted:
27
04
2020
pubmed:
4
5
2020
medline:
15
5
2021
entrez:
4
5
2020
Statut:
ppublish
Résumé
Graft occlusion after coronary artery bypass graft surgery (CABG) has been associated with native coronary artery competitive flow. The present study aims to characterize the functional progression of coronary artery disease (CAD) in native vessels after CABG, and to assess the relationship between preoperative FFR as derived from angiography and graft occlusion. Multicenter study of consecutive patients undergoing CABG between 2013 and 2018, in whom a follow-up angiogram had been performed. Serial vessel-fractional flow reserve (vFFR) analyses were obtained in each major native coronary vessel before and after CABG, excluding post-anastomotic segments and graft conduits. In 73 patients, serial angiograms were suitable for vFFR analysis, including 118 grafted (86 arterial and 32 saphenous grafts) and 64 non-grafted vessels. The median time between CABG and follow-up angiography was 2.4 years [IQR 1.5, 3.3]. Functional CAD progression, by means of decline in vFFR, was observed in grafted but not in non-grafted vessels (delta vFFR in grafted vessels 0.10 [IQR 0.05, 0.18] vs. 0.01 [IQR -0.01, 0.03], in non-grafted vessels, p < 0.001). Preoperative vFFR predicted graft occlusion (AUC: 0.66, 95% CI 0.52 to 0.80, p = 0.031). In patients undergoing CABG, preoperative vFFR derived from conventional angiograms without use of pressure wire was able to predict graft occlusion. Graft occlusion was more frequent in vessels with high vFFR values. Grafted native coronary vessels exhibited accelerated functional CAD progression, whereas in non-grafted native coronaries the functional status remained unchanged.
Sections du résumé
BACKGROUND
Graft occlusion after coronary artery bypass graft surgery (CABG) has been associated with native coronary artery competitive flow.
OBJECTIVES
The present study aims to characterize the functional progression of coronary artery disease (CAD) in native vessels after CABG, and to assess the relationship between preoperative FFR as derived from angiography and graft occlusion.
METHODS
Multicenter study of consecutive patients undergoing CABG between 2013 and 2018, in whom a follow-up angiogram had been performed. Serial vessel-fractional flow reserve (vFFR) analyses were obtained in each major native coronary vessel before and after CABG, excluding post-anastomotic segments and graft conduits.
RESULTS
In 73 patients, serial angiograms were suitable for vFFR analysis, including 118 grafted (86 arterial and 32 saphenous grafts) and 64 non-grafted vessels. The median time between CABG and follow-up angiography was 2.4 years [IQR 1.5, 3.3]. Functional CAD progression, by means of decline in vFFR, was observed in grafted but not in non-grafted vessels (delta vFFR in grafted vessels 0.10 [IQR 0.05, 0.18] vs. 0.01 [IQR -0.01, 0.03], in non-grafted vessels, p < 0.001). Preoperative vFFR predicted graft occlusion (AUC: 0.66, 95% CI 0.52 to 0.80, p = 0.031).
CONCLUSIONS
In patients undergoing CABG, preoperative vFFR derived from conventional angiograms without use of pressure wire was able to predict graft occlusion. Graft occlusion was more frequent in vessels with high vFFR values. Grafted native coronary vessels exhibited accelerated functional CAD progression, whereas in non-grafted native coronaries the functional status remained unchanged.
Identifiants
pubmed: 32360649
pii: S0167-5273(19)35905-4
doi: 10.1016/j.ijcard.2020.04.083
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
19-25Informations de copyright
Copyright © 2020. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Declaration of competing interest CC report receiving research grants from Biosensor, Heart Flow Inc. and Abbott Vascular; and consultancy fees from Heart Flow Inc. and Philips Volcano. JS reports a research grant provided by Cardiopath Ph.D program. TM report receiving consultancy fees from Heart Flow Inc. EM reports institutional grant support from Abbott Vascular, Boston Scientific, and Biotronik. DA reports institutional fees as a speaker and clinical research grants from GE, Bracco, and Heartflow. BDB reports receiving consultancy fees on his behalf from Boston Scientific and Abbott Vascular. The other authors have nothing to disclose. This study was supported by the VZW Cardiovascular Research Centre, Aalst, Belgium.