Summary
This observational analysis of 1539 participants from the PREVENT IV trial identified internal mammary artery graft failure in 8.6% of cases at 12–18 months post-coronary artery bypass grafting. Left anterior descending (LAD) stenosis <75%, the presence of an additional bypass graft to the diagonal branch, and absence of diabetes mellitus were significant predictors of IMA failure. IMA failure was associated with substantially higher rates of repeat revascularisation, raising concerns about the adequacy of coronary revascularisation in intermediate LAD stenosis without functional evidence of ischaemia.
UK applicability
These findings are directly applicable to UK cardiac surgery practice, as coronary artery bypass grafting protocols and IMA graft techniques are standardised across the National Health Service. The data on graft failure predictors may inform pre-operative risk stratification and patient counselling in UK cardiac centres.
Key measures
IMA graft failure (≥75% stenosis) incidence and predictors; odds ratios for graft failure; incidence of subsequent acute clinical events; rates of repeat revascularisation
Outcomes reported
The study examined the frequency of internal mammary artery (IMA) graft failure (≥75% stenosis) and identified predictors of failure at 12–18 months post-operatively. It assessed the relationship between IMA failure and subsequent clinical outcomes including death, myocardial infarction, and repeat revascularisation.
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