Intimal hyperplasia, saphenous vein graft disease, and clinical outcomes: Insights from the CTSN VEST randomized trial

Abstract

OBJECTIVE

Diffuse intimal hyperplasia and graft irregularity adversely affect long-term patency of saphenous vein grafts and clinical outcomes of patients undergoing CABG. The VEST trial evaluated the efficacy of external graft support to limit the development of intimal hyperplasia one-year post surgery. This secondary analysis explored the association between graft disease and intimal hyperplasia and clinical events. We also examined risk factors for early graft occlusion.

METHODS

VEST is a within-patient randomized, multicenter trial that enrolled 224 patients with multi-vessel coronary disease undergoing CABG surgery, of whom 203 were evaluated by one-year. Intimal hyperplasia, lumen uniformity, graft stenosis and graft perfusion were measured by intravascular ultrasound and angiography. Major cardiac and cerebrovascular events (MACCE, including death, MI, stroke and revascularization) were collected during a median follow-up of 3 years.

RESULTS

Worse lumen uniformity, higher level of stenosis and worse graft perfusion were associated with higher values of intimal hyperplasia area and increased incidence of clinical events. Consistent with previous findings, we found that endoscopic vein harvesting, female sex and TTFM pulsatility index and flow were risk factors for SVG occlusion during the first year post surgery.

CONCLUSIONS

In this secondary analysis of the VEST trial, we observed an association between intimal hyperplasia area and clinical measures of SVG disease at one-year post surgery. More severe SVG disease and larger intimal hyperplasia areas were associated with a higher incidence of 3-year MACCE. Ongoing follow-up to 5 years will further elucidate the impact of vein graft disease on long-term clinical outcomes of CABG.