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Ann Thorac Surg 2005;80:896-901
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Do Angiographic Results From Symptom-Directed Studies Reflect True Graft Patency?

^a Department of Cardiac Surgery, Austin Hospital, Melbourne
^b Department of Cardiology, Austin Hospital, Melbourne
^c Statistical Consulting Centre, University of Melbourne, Parkville, Victoria, Australia

Accepted for publication March 23, 2005.

^_* Address reprint requests to Dr Buxton, Department of Cardiac Surgery, Austin Hospital, Studley Rd, Heidelberg, Victoria 3084, Australia (Email: brian.buxton{at}austin.org.au).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Coronary artery graft patency results have been obtained from repeat angiograms in patients who presented with evidence of ischemia. The purpose of this study is to compare protocol-directed angiographic results from a randomized clinical trial with symptom-directed angiography in nontrial patients.

METHODS: Repeat angiography after primary isolated coronary artery bypass grafting was performed in 337 of 2,259 patients between July 1996 and September 2004. Patients were divided into two groups: 596 graft angiograms in 192 trial patients were compared with 389 graft angiograms in 142 nontrial patients. The mean interval from surgery was 1,306 ± 800 days versus 1,119 ± 777 days, respectively. Grafting techniques were similar in both groups except that the right internal thoracic artery was used almost exclusively as a free graft in the trial patients. Angiographic outcomes were defined as patent (stenosis <80%) or failure (stenosis 80%, occlusion, or the string sign). Comparisons of trial versus nontrial grafts were made using a generalized linear mixed model. Five-year estimates of graft patency were made using survival analyses accounting for interval censoring.

RESULTS: The odds ratio for graft failure for nontrial compared with trial patient grafts was 2.6 (95% confidence interval, 1.6 to 4.3; p < 0.001). Cumulative patency estimates for all grafts at 5 years were trial 91% versus nontrial 83%, p = 0.004. Five-year estimates for individual conduits were left internal thoracic artery, 99% versus 92%, p = 0.002; right internal thoracic artery, 86% versus 87%, p = 0.8; radial artery, 87% versus 86%, p = 0.6; and saphenous vein, 86% versus 56%, p = 0.003.

CONCLUSIONS: Graft patency rates were superior in the trial compared with nontrial patients. Symptom-directed graft failure rates were approximately double those of trial patients.

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