Predictors of early saphenous vein aortocoronary bypass graft occlusion. The GESIC Study Group.

Abstract

To identify factors determining early saphenous vein aortocoronary bypass occlusion, we analyzed the data base of the GESIC study, a trial comparing antiplatelet drug regimens that included 927 patients with 1,854 saphenous vein grafts. The univariate analysis showed female sex (p < 0.0097), obesity (p < 0.001), rest angina (p < 0.0026), history of congestive heart failure (p < 0.037), the revascularized artery (p < 0.0001), the quality of distal bed (p < 0.00001), the diameter of the grafted vessel (p < 0.00001), the lack of antiaggregant treatment (p < 0.017), and a nonsequential technique (p < 0.0002) as predictors of early (28 days) graft occlusion. In the multivariate analysis the last five variables were independent predictors. Using the two preoperative variables, it was possible to identify groups at different risk; the occlusion rate ranged between 8.79% (left anterior descending coronary artery and good distal vessel) and 27.58% (right coronary artery or left circumflex coronary artery and poor distal vessel). The combination of three variables (grafted vessel, artery diameter, and antiaggregant treatment) also allowed identification of different risk groups; the occlusion rate ranged between 3.5% and 63.1%. Thus, it is possible to anticipate the risk of graft occlusion in patients undergoing coronary artery bypass grafting, which may help in the selection of both patients and antithrombotic treatment.