Association between early vein graft failure and long-term major adverse cardiovascular events following off-pump coronary artery bypass grafting: an exploratory retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Early vein graft failure (VGF) following coronary artery bypass grafting (CABG) is far from rare and often clinically silent. While mid-to-late graft failure is established to predict adverse clinical events, the long-term prognostic impact of predischarge early VGF remains poorly defined. This study aimed to evaluate the association between early VGF and 10-year clinical outcomes following off-pump CABG.Methods: In this exploratory retrospective cohort study, adult patients undergoing elective isolated off-pump CABG using vein grafts with early postoperative coronary computed tomography angiography between July 2014 and December 2015 were consecutively included. Baseline, intraoperative, and postoperative data were collected from electronic medical records. VGF was defined as Fitzgibbon grade B (≥50% stenosis) or O (occlusion). Patients were stratified into the early VGF group (with at least one failed vein graft) and non-early VGF group (without failed vein grafts). Clinical follow-up was conducted through routine outpatient visits or standardized telephone interviews in accordance with institutional protocol. Primary outcomes included 10-year major adverse cardiovascular events (MACE, composite of all-cause death, myocardial infarction, stroke, or revascularization) and its individual components. Secondary outcomes included perioperative myocardial injury and perioperative myocardial infarction (PMI). Propensity score overlap weighting was applied to adjust for baseline confounders. Exploratory post-hoc landmark and piecewise Cox analyses were performed to address non-proportional hazards.Results: A total of 233 patients were included in the analyses (mean age 64.3±7.5 years; 18.4% female). Among them, early VGF was identified in 33 (14.2%) patients and 41 (5.9%) vein grafts. Early VGF numerically increased the risk of perioperative myocardial injury [45.5% vs. 30.5%, odds ratio (OR) 1.90, 95% confidence interval (CI): 0.89–4.01; P=0.09] and PMI (12.1% vs. 6.0%, OR 2.16, 95% CI: 0.57–6.69; P=0.21), though without statistical significance. Over a median follow-up of 9.6 years, there was no statistically significant difference in 10-year MACE between the two groups [early VGF 51.5% vs. non-early VGF 48.2%; adjusted hazard ratio (aHR) 1.31, 95% CI: 0.76–2.24; P=0.33]. In exploratory landmark analyses addressing non-proportional hazards (P=0.03), early VGF was associated with a higher risk of MACE within the first 2 years post-surgery (aHR 2.18, 95% CI: 1.14–4.17; P=0.02), which attenuated beyond the 2-year landmark (aHR 0.56, 95% CI: 0.22–1.46; P=0.24). Additionally, early VGF was associated with a higher risk of repeat revascularization (18.2% vs. 7.7%; aHR 3.06, 95% CI: 1.13–8.31; P=0.03).Conclusions: Predischarge early VGF was not significantly associated with the overall 10-year risk of MACE following off-pump CABG. Exploratory findings regarding early risk clustering within 2 years and an increased risk of repeat revascularization remain hypothesis-generating. Further prospective studies are warranted to validate these observations.
Source: Journal of Thoracic Disease
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224085761