The association between coronary graft patency and clinical status in patients with coronary artery disease

Abstract

The concept of a direct association between coronary graft patency and clinical status is generally accepted. However, the relationship is more complex and variable than usually thought. Key issues are the lack of a common definition of graft occlusion and of a standardized imaging protocol for patients undergoing coronary bypass surgery. Factors like the type of graft, the timing of the occlusion, and the amount of myocardium at risk, as well as baseline patients' characteristics, modulate the patency-to-clinical status association. Available evidence suggests that graft occlusion is more often associated with non-fatal events rather than death. Also, graft failure due to competitive flow is generally a benign event, while graft occlusion in a graft-dependent circulation is associated with clinical symptoms. In this systematic review, we summarize the evidence on the association between graft status and clinical outcomes.

Keywords: CABG; Graft failure; Patency.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.

Figures

Variables modulating the interaction between graft occlusion and clinical status.

Figure 1

Pathophysiology of graft failure in different postoperative periods.

Figure 2

Reduction in graft failure using fractional flow reserve for coronary artery bypass grafting. Reproduced with permission from Spadaccio et al.

Figure 3

Number of published studies reporting an association between graft patency and fatal or non-fatal events. As shown, graft occlusion is generally associated with non-fatal events rather than death.