Angiographic Correlates of Graft Patency and Relationship to Clinical Outcomes

Retained graft patency after revascularization lowers risk of subsequent myocardial infarction or death. Patients who have surgical rather than medical therapy are far less likely to die of a subsequent nonperioperative infarction. Both myocardial infarction size and lethality are modified by prior coronary artery bypass grafting. The procedure risk for either death or nonfatal infarction remains higher in coronary artery bypass grafting than in angioplasty, but among patients who survive for 30 days, subsequent risk is only two-thirds that of patients who had angioplasty. Better graft patency rates are associated with the use of an internal thoracic artery rather than a saphenous vein, larger size of the recipient coronary artery, and better blood flow through the grafts. Aspirin therapy clearly decreases the occlusion rate per distal anastomosis, but aprotinin therapy appears to have little or no effect on graft patency. Numerous other factors can influence graft patency. Prominent among the factors increasing risk for requirement of a reoperation are nonuse of an internal thoracic artery, incomplete revascularization, and continued cigarette smoking.