Abstract
Background Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is
a challenge due to its complexity. Thus, data on the outcomes after coronary artery
bypass graft (CABG) in this population is scarce. In this study, we aimed to determine
the impact of CABG on the clinical and functional status, as well as graft patency
in those individuals.
Methods Patients with severe and diffuse CAD who underwent incomplete CABG due to complex
anatomy or extensive distal coronary involvement were evaluated preoperatively and
1 year after surgery. Postoperative coronary angiography was performed to evaluate
graft patency. Graft occlusion was defined as the complete absence of opacification
of the target vessel. Stratified analysis of graft occlusion was performed by graft
type and territories, defined as left anterior descending artery (LAD), the left circumflex
branch, and the right coronary artery territories; the latter two, grouped, were further
classified as non-LAD territory.
Results A total of 57 patients were included, in whom 131 grafts were placed. There was a
significant improvement in Canadian Cardiovascular Society angina symptom severity
(Z = –6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference
between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal
mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year
(odds ratio: 4.03; p = 0.016).
Conclusion In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical
improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA
grafts to the LAD territory.
Keywords
coronary artery bypass graft surgery - coronary artery disease - graft occlusion
