Predictors of Aorto–Saphenous Vein Bypass Narrowing Late After Coronary Artery Bypass Grafting

      The objective of this study was to evaluate the clinical and angiographic factors associated with significant saphenous vein graft (SVG) atherosclerosis progression at mid-term follow-up in a series of unselected coronary patients who had previously received a coronary artery bypass graft (CABG). A total of 123 SVGs from 86 patients who underwent cardiac catheterization twice, 15 ± 12 months apart, were included in the study. None of the SVGs presented any ≥50% diameter stenosis (DS) lesion or underwent any intervention at baseline. All SVGs were divided into 3 segments and each SVG segment was scored from 0 to 3 depending on the presence of lesions, with percent DS ranging from 0% to 19% (score 0), 20% to 29% (score 1), 30% to 39% (score 2), and ≥40% (score 3). The SVG atherosclerotic burden score (ABS) was calculated by adding the score obtained for each of the 3 SVG segments. Significant progression was defined as ≥10% increase in lesion percent DS or ≥0.6 mm decrease in minimal lumen diameter between baseline and follow-up studies. Mean age of the study population was 66 ± 9 years, and most of the patients were receiving statin therapy with mean low-density lipoprotein cholesterol of 85 ± 26 mg/dl. Significant angiographic progression occurred in ≥1 SVG in 41 patients (48%). On multivariate analysis, the variables associated with SVG atherosclerosis progression were SVG ABS (odds ratio [OR], 1.52 for each increase of 1 point in SVG ABS; 95% confidence interval [CI] 1.1 to 2.29) and high-density lipoprotein (HDL) cholesterol (OR 1.38 for each decrease of 5 mg/dl in HDL cholesterol levels, 95% CI 1.09 to 1.85). Twenty-two patients (26%) had a cardiac event at follow-up related to SVG disease progression. The percent DS of the SVG segment at baseline was associated with SVG disease progression leading to a cardiac event (OR 3.67 for each increase of 5% in percent DS, 95% CI 2.11 to 6.38). In conclusion, simple clinical and angiographic variables such as HDL cholesterol, ABS, and lesion severity remain independent predictors of significant SVG atherosclerosis progression in mild to moderately diseased SVGs despite mean low-density lipoprotein levels <90 mg/dl.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • The Post Coronary Artery Bypass Graft Trial Investigators
        The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts.
        N Engl J Med. 1997; 336: 153-162
        • Chen L.
        • Théroux P.
        • Lespérance J.
        • Shabani F.
        • Thibault B.
        • De Guise P.
        Angiographic features of vein grafts versus ungrafted coronary arteries in patients with unstable angina and previous bypass surgery.
        J Am Coll Cardiol. 1996; 15: 1493-1499
        • Keely E.C.
        • Velez C.A.
        • O’Neill W.
        • Safian R.D.
        Long-term clinical outcome and predictors of major adverse cardiac events afer percutaneous interventions on saphenous vein grafts.
        J Am Coll Cardiol. 2001; 38: 659-665
        • Mehta R.H.
        • Honeycutt E.
        • Shaw L.K.
        • Glower D.
        • Harrington R.A.
        • Sketch M.H.
        Clinical correlates of long-term mortality after percutaneous interventions of saphenous vein grafts.
        Am Heart J. 2006; 152: 801-806
        • Domanski M.J.
        • Borkowf C.B.
        • Campeau L.
        • Knatterud G.L.
        • White C.
        • Hoogwerf B.
        • Rosenberg Y.
        • Geller N.L.
        Prognostic factors for atherosclerosis progression in saphenous vein grafts.
        J Am Coll Cardiol. 2000; 36: 1877-1883
        • Knatterud G.L.
        • White C.
        • Geller N.L.
        • Campeau L.
        • Forman S.A.
        • Domanski M.
        • Forrester J.S.
        • Gobel F.L.
        • Herd A.
        • Hickey A.
        • et al.
        Angiographic changes in saphenous vein grafts are predictors of clinical outcomes.
        Am Heart J. 2003; 145: 262-269
        • Ellis S.G.
        • Brener S.J.
        • DeLuca S.
        • Tuzcu M.
        • Raymond R.E.
        • Whitlow P.L.
        • Topol E.
        Late myocardial ischemic events after saphenous vein graft intervention: importance of initially “nonsignificant” vein graft lesions.
        Am J Cardiol. 1997; 79: 1460-1464
        • Le May M.R.
        • Labinaz M.
        • Marquis J.F.
        • Laramée L.A.
        • O’Brien E.R.
        • Williams W.L.
        • Jelley J.L.
        • Woodend K.
        • Higginson L.A.
        Predictors of long-term outcome after stent implantation in a saphenous vein graft.
        Am J Cardiol. 1999; 83: 681-686
        • Libby P.
        Managing the risk of atherosclerosis: the role of high-density lipoprotein.
        Am J Cardiol. 2001; 88: 3N-8N
        • Gordon T.
        • Castelli W.P.
        • Hjortland M.C.
        • Kannel W.B.
        • Dawber T.R.
        High density lipoprotein as a protective factor against coronary heart disease.
        Am J Med. 1977; 62: 707-714
        • Sharrett A.R.
        • Ballantyne C.M.
        • Coady S.A.
        • Heiss G.
        • Sortie P.D.
        • Catellier D.
        • Patsch W.
        Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein (a), apolipoprotein A-1 and B, and HDL density subfractions.
        Circulation. 2001; 104: 1108-1113
      1. Neitzel G, Barboriak J, Pintar K, Qureshi I. Atherosclerosis in aortocoronary bypass grafts: morphological study and risk factor analysis 6 to 12 years after surgery. Arteriosclerosis 1986;594–600.