Evaluation of evolocumab on saphenous vein graft patency following coronary artery bypass graft surgery in people living with and without diabetes in the NEWTON-CABG CardioLink-5 trial.

Background Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. Method This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 ± 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. Results Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823–0.924; p < 0.001). Conclusion The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency.

We read the article ‘‘Preoperative Neutrophil–Lymphocyte Ratio and Saphenous Vein Graft Patency After Coronary Artery Bypass Grafting’’ by Tasoglu et al. They aimed to investigate the predictive value of preoperative neutrophil–lymphocyte (N/L) ratio in postoperative saphenous vein graft (SVG) patency in patients undergoing coronary artery bypass grafting (CABG) surgery. They showed that the N/L ratio is a powerful and independent predictor of further SVG failure after CABG. Patients in the highest tertile of N/L ratio were at greater risk. The study is successful in planning and presenting the results. We believe that these findings will enlighten further studies about the postoperative SVG patency and the N/L ratio. Thanks to the authors for their contribution Coronary lesion severity should be examined using both anatomical and physiological myocardial ischemia methods. Although coronary angiography is the conventional gold standard anatomical evaluation method, intravascular ultrasound and optical coherence tomography give useful information about the severity of coronary artery stenosis. Additionally, fractional flow reserve value has also become a necessary tool for the functional severity of coronary artery stenosis recently. All of these methods should be used together to evaluate the severity of coronary artery stenosis. Routine peripheral blood counts may be helpful in patients with postoperative SVG patency undergoing CABG surgery. White blood cell (WBC) count is one of the useful inflammatory biomarkers in clinical practice. Although WBC is in the normal range, subtypes of WBC like N/L ratio may predict cardiovascular mortality. The N/L ratio is a readily measurable laboratory marker used to evaluate systemic inflammation. Because of uncontrolled hypertension, uncontrolled diabetes mellitus, metabolic syndrome, left ventricular dysfunction or hypertrophy, acute coronary syndromes, valvular heart disease, congenital heart disease, abnormal thyroid function tests, renal or hepatic dysfunction, known malignancy, local or systemic infection, previous history of infection (<3 months), inflammatory diseases, and any medication related to inflammatory condition of patients, the measurement of N/L ratio can be potentially affected in all of the above conditions. For these reasons, it would be better if the authors had mentioned these factors. Finally, not only the N/L ratio but also the mean platelet volume, red cell distribution width, uric acid, a g-glutamyl transferase, and carotid intima–media thickness are easy methods to assess the SVG patency in patients with CABG. These markers might be useful in clinical practice. In conclusion, we strongly believe that those findings obtained from the current study will lead to further large-scale studies examining the relationship between the N/L ratio and the SVG patency in patients with CABG. However, one should keep in mind that the N/L ratio alone without other inflammatory markers may not give exact information to clinicians about the inflammatory status and SVG patency of the patients. So, from that point of view we think that it should be evaluated accompanied with other serum inflammatory markers.

Saphenous vein graft (SVG) patency remains a challenge in cases of coronary artery disease following coronary artery bypass grafting (CABG) surgery. The Naples prognostic score (NPS) constitutes a novel scoring system designed to assess both nutritional status and inflammation. Our study aimed to explore the association between the NPS and SVG disease in patients with a previous history of CABG surgery. A total of 702 patients who had undergone CABG surgery and underwent coronary angiography were reviewed retrospectively. SVG disease was defined as the presence of ≥50% stenosis in at least one SVG. Patients were categorized into two groups based on the presence or absence of SVG disease. Values of p<0.05 were accepted as statistically significant. The study population consisted of 702 patients, with 269 (38.3%) having degenerative SVGs and 433 (61.7%) without degenerative SVGs. The NPS was higher in the group with saphenous vein degeneration and emerged as a significant predictor of SVG disease (OR: 1.596, 95% CI: 1.198-2.125, p=0.001). Additionally, hypertension (OR: 2.344, 95% CI: 1.137-4.833, p=0.02), chronic kidney disease (OR: 3.337, 95% CI: 1.554-7.168, p=0.002), statin usage (OR: 0.434, 95% CI: 0.239-0.789, p=0.006), time interval since CABG (OR: 1.138, 95% CI: 1.213-1.432, p<0.001), and number of SVGs (OR: 2.708, 95% CI: 1.902-3.855, p<0.001) were significant predictors of SVG disease. The NPS, a useful tool for assessing inflammation and nutritional status, could provide valuable information about the patency of SVGs following CABG surgery. Patients with elevated NPS after CABG should undergo careful monitoring for the development of SVG disease.

ResumoFundamento A permeabilidade do enxerto de veia safena (EVS) continua sendo um desafio em casos de doença arterial coronária após cirurgia de revascularização do miocárdio (CRM). O escore prognóstico de Nápoles (NPS) constitui um novo sistema de pontuação projetado para avaliar tanto o estado nutricional quanto a inflamação.Objetivos Nosso estudo teve como objetivo explorar a associação entre NPS e doença do EVS em pacientes com histórico prévio de CRM.Métodos Foram revisados um total de 702 pacientes submetidos à CRM e à angiografia coronáriaretrospectivamente. A doença do EVS foi definida como a presença de estenose ≥50% em pelo menos um EVS. Os pacientes foram categorizados em dois grupos com base na presença ou ausência de doença do EVS. Valores de p<0,05 foram aceitos como estatisticamente significativos.Resultados A população do estudo consistiu em 702 pacientes, com 269 (38,3%) apresentando EVSs degenerativos e 433 (61,7%) sem EVSs degenerativos. O NPS foi maior no grupo com degeneração da veia safena e surgiu como um preditor significativo de doença do EVS (OR: 1,596, IC 95%: 1,198-2,125, p=0,001). Além disso, hipertensão (OR: 2,344, IC 95%: 1,137-4,833, p=0,02), doença renal crônica (OR: 3,337, IC 95%: 1,554-7,168, p=0,002), uso de estatina (OR: 0,434, IC 95%: 0,239-0,789, p=0,006), intervalo de tempo desde a CRM (OR: 1,138, IC 95%: 1,213-1,432, p<0,001) e número de EVSs (OR: 2,708, IC 95%: 1,902-3,855, p<0,001) foram preditores significativos da doença do EVS.Conclusão O NPS, uma ferramenta útil para avaliar inflamação e estado nutricional, pode fornecer informações valiosas sobre a permeabilidade de EVSs após cirurgia de CRM. Pacientes com NPS elevado após CRM devem passar por monitoramento cuidadoso para o desenvolvimento de doença de EVS.

Ischemic heart disease is a significant cause of mortality and morbidity in Western populations. Consistent with this, coronary artery bypass graft (CABG) surgery remains one of the most frequently performed major surgeries. Improved survival rates mean that our research focus now extends beyond surgical technique to include quality of postoperative outcome. Postoperative cognitive dysfunction (POCD) has emerged as one of the most challenging and hotly debated issues, with increasing impetus to answer the unresolved question: does fixing the heart come at a cost to the brain? CABG surgery is associated with neurological events including stroke in 1.6%1 and delirium in 5.8%2 of patients. Beyond these severe and marked alterations to neurological function, there has been a widely held belief that CABG surgery is associated with POCD, which may presage a decline toward dementia. Research has been influenced by the 1995 Consensus Statement3 into the study of POCD in patients undergoing CABG surgery. Although the methods of investigation set forth by the Consensus Statement achieved widespread acknowledgment, its specific recommendations have not always been followed.4 Despite significant methodological issues, it seems that the balance of interpretation has historically been in favor of CABG surgery as a cause of significant POCD. More recently, however, a review of a series of publications from a well-controlled longitudinal cohort study conducted at Johns Hopkins5 and a meta-analysis6 suggested that cognition is in fact stable or may even show some improvement after CABG surgery in the majority of patients, at least within the first year (Figures 1 and 2). There is little doubt that POCD affects some patients in the short term, but the pathophysiological mechanisms underlying this and the influence on longer-term cognitive function remain uncertain. For research to progress, we require a paradigmatic shift in our focus from …

Effects of Aspirin Responsiveness and Platelet Reactivity on Early Vein Graft Thrombosis After Coronary Artery Bypass Graft Surgery

Objective: Coronary artery bypass graft (CABG) surgery is a common treatment method in which saphenous vein grafts (SVG) and arterial grafts are used together in severe coronary artery disease. The CHA2DS2-VASc score is used to predict thromboembolic events in nonvalvular atrial fibrillation as well as to predict prognosis in cardiovascular events. In this study, we planned to research the relation between CHA2DS2-VASc score and postoperative SVG patency rates in patients undergoing CABG.&#x0D; Materials and Methods: One hundred seventeen patients with angina after CABG surgery who underwent coronary angiography were analyzed retrospectively. Stenosis of 50% or more in at least one saphenous vein graft was accepted as saphenous vein graft disease (SVGD). We compared these patients in two groups concerning the presence of 50% or more stenosis in the SVG. These two groups were; Group 1 (n = 66); with saphenous vein graft disease, Group 2 (n = 51) without saphenous vein graft disease, respectively.&#x0D; Results: A total of 117 patients participating in the study. Sixty-six patients in group 1 had SVGD (Mean age: 68,13±8,22, 60,6% male). Fifty-one patients in group 2 did not have SVGD (Mean age: 66,92±9,44, 72,5% male ). The mean CHA2DS2-VASc score was significantly higher in group 1 compared to group 2. [5 (2-7) vs. 2 (1-7), respectively, P&lt;0,001]. As a result of multivariate analysis, CHA2DS2-VASc score (OR: 5,263, CI 95%: 2,176- 12,728, P&lt;0.001) and SII (OR: 1,236, CI 95%: 1,120-2,955, P=0.007) were determined as independent predictors for predicting SVGD&#x0D; Conclusion: In the light of the results we have found, the CHA2DS2-VASc score and SII, which are easy to calculate in daily practice, can help us in predicting SVGD.

Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG. In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with ≥1 SVGs were randomly assigned (1:1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death. Among 499 randomly assigned patients, the mean age was 67.9±8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]). In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02352402.

Platelets are involved in the pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in red blood cell distribution width (RDW) and platelet distribution width (PDW) values. Therefore, in this study we aimed to investigate whether PDW and RDW are associated with the patency of saphenous vein graft in patients at least 1year after coronary artery bypass graft (CABG) surgery. Patients who had undergone CABG surgery at least 1year previously with at least one saphenous vein graft were included in the study population. Patients were referred to cardiac catheterization for stable anginal symptoms or positive stress test results. Before coronary angiography, all patients referred had routine blood tests including RDW and PDW values. Saphenous vein grafts were found to be patent in 69patients and occluded in 40patients. Although RDW levels were similar between patients with patent and occluded grafts (13.1 ± 1.1% and 13.2 ± 0.7% respectively, p = 0.37), PDW levels were significantly different between the two groups (13.1 ± 1.3% and 14.1 ± 1.1 respectively, p = 0.03). Although time after CABG operation differs significantly between the two groups (p < 0.001), multiple logistic regression analyses showed that PDW levels were found to be significantly associated with the patency of vein graft (β = 1.682, 95%CI 1.117-2.532, p = 0.013). Our results showed that PDW levels were higher in patients with an occluded saphenous vein graft. However no association was found between the saphenous vein graft disease and RDW values. To verify this relationship between PDW values and saphenous vein graft patency, further investigations are needed.

Effect of anti-platelet factor-4/heparin antibody induction on early saphenous vein graft occlusion after coronary artery bypass surgery.

Tranexamic acid and early saphenous vein graft patency in conventional coronary artery bypass graft surgery: A prospective randomized controlled clinical trial

Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study

Dual anti-platelet therapy (DAPT) after coronary artery bypass graft surgery (CABG) has drawn a lot of controversy. This study aimed to explore the effects of ticagrelor combined with aspirin (compared with aspirin combined with clopidogrel) on the patency of saphenous vein graft (SVG) after off-pump CABG. This was a prospective, randomized, double-blinded clinical controlled trial. Participants were first given aspirin (100 mg/d) within 12 h after off-pump CABG, followed by P2Y12 receptor antagonist (Orally, 75 mg/time of clopidogrel, once daily, for Group C and 90 mg/time of ticagrelor, twice daily, for Group T) within 24 h after off-pump CABG for one year. Computed tomography angiography (CTA) was conducted for all patients. The incidence of major adverse cardiac events(MACE), death, stroke, hemorrhage, left ventricular diameter (LVD), and left ventricular ejection fraction (LVEF) of the participants was assessed one year after off-pump CABG based on a 12-month follow-up. A total of 73 participants completed the follow-up, and 219 bypass grafts, including 146 SVGs, were conducted. Notably, 11 bypass grafts (SVGs) were exposed to occlusion (9 in Group C and 2 in Group T). The overall occlusion rates of bypass grafts and SVGs of Groups C and T were significantly different (9/114 vs. 2/105, P = 0.043, 9/76 vs. 2/70, P = 0.04). Moreover, multivariate binary Logistic regression demonstrated that ticagrelor + aspirin anti-platelet therapy could reduce the stenosis risk of bypass grafts (OR = 0.195, 95% CI = 0.039-0.978, P = 0.047). Compared with clopidogrel, ticagrelor may reduce the occlusion rate of vein grafts after CABG. [https://www.chictr.org/], identifier [ChiCTR1900022390].

CRT-132 Under-Utilization of Statins and Aspirin Following Coronary Artery Bypass Graft Surgery

Patency of Saphenous Vein Grafts Using the PAS-Port System During Coronary Artery Bypass Surgery