Abstract 20311: Identifying Biological Predictors of Early Saphenous Vein Graft Failure: A Meta-Analysis of 5134 Patients With Angiographic Follow Up in SAFINOUS-CABG Collaborative Group

• Published in: Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A20311
• Main Authors: Oikonomou, Evangelos K, Odutayo, Ayodele, Akoumianakis, Ioannis, Antonopoulos, Alexios, Thomas, Sheena, Herdman, Laura, Trivella, Marialena, Collins, Gary, Petrou, Mario, Channon, Keith, Antoniades, Charalambos
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 11.11.2016
• ISSN: 0009-7322; 1524-4539

IntroductionEarly failure of saphenous vein grafts (SVG) used in coronary artery bypass grafting (CABG) is often attributed to technical factors. We explore the contribution of biological factors relevant to either the quality of the SVG or the patient’s risk profile, in predicting early SVG failure.MethodsIn study 1, 176 patients undergoing CABG with ≥1 SVG in Oxford University Hospitals were recruited. Intact SVG segments were obtained before distension to study endothelial nitric oxide (NO) bioavailability ex vivo (vasorelaxation to acetylcholine (ACh 3x10-8μ, n=57) and quantify superoxide (O2-) generation (n=121). The contribution of uncoupled nitric oxide synthase (NOS) and NADPH oxidases in SVG redox balance was determined using NOS inhibitor LNAME and NADPH oxidases inhibitor Vas2870 respectively. SVG patency was determined using CT angiography 6 weeks post CABG. In study 2, data from 8 studies in SAFINOUS-CABG (n=5134 CABG cases with angiographic follow up <1y post-CABG) were used in a meta-analysis, searching for patient-specific biological predictors of early SVG failure.ResultsThere were 20 patients with ≥1 failed SVG (11.36%) in Study 1. Failed SVGs had impaired vasorelaxation to ACh (A) but similar resting O2- (B) and similar NADPH-stimulated or Vas2870-inhibitable O2-, compared to non-failed SVGs (data not shown). In SAFINOUS-CABG study, average SVG failure was 9.17% within the first year, and gender was the strongest predictor (C).ConclusionsThis is the first study demonstrating that biological factors like NO bioavailability of the intact SVG (before surgical preparation) predict early graft failure in CABG. Further to the biology of the SVGs and a variety of technical factors, patient characteristics (e.g. gender) are also driving early SVG failure. We propose a predictive model of early SVG failure based on both patient-specific and technical factors, that will guide therapeutic strategies following CABG.