Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting
Background In coronary artery bypass grafting, grafting a target vessel with nonsignificant stenosis increases the risk of graft failure. The present study aims to investigate the impact of preoperative quantitative flow ratio (QFR), a novel functional assessment of the coronary artery, on internal...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.029134 |
| _version_ | 1797810170098614272 |
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| author | Chunyuan Wang Zhan Hu Zhihui Hou Yang Wang Lei Song Bo Xu Changdong Guan Yu Ning Wei Feng Yan Zhang |
| author_facet | Chunyuan Wang Zhan Hu Zhihui Hou Yang Wang Lei Song Bo Xu Changdong Guan Yu Ning Wei Feng Yan Zhang |
| author_sort | Chunyuan Wang |
| collection | DOAJ |
| description | Background In coronary artery bypass grafting, grafting a target vessel with nonsignificant stenosis increases the risk of graft failure. The present study aims to investigate the impact of preoperative quantitative flow ratio (QFR), a novel functional assessment of the coronary artery, on internal mammary artery graft failure rate and midterm patient outcomes. Methods and Results Between January 2016 and January 2020, we retrospectively included 419 patients who underwent coronary artery bypass grafting who had received preoperative angiography and postoperative coronary computed tomographic angiography in our center. QFR of the left anterior descending (LAD) artery was computed based on preoperative angiograms. The primary end point was the failure of the graft on the LAD artery assessed by coronary computed tomographic angiography at 1 year, and the secondary end point was major adverse cardiac and cerebrovascular events including death from any cause, myocardial infarction, stroke, or repeat revascularization. Grafts on functionally nonsignificant LAD arteries (QFR >0.80) had a significantly higher failure rate than those on functionally significant LAD arteries (31.4% versus 7.2%, P<0.001). QFR outperforms degree of stenosis in discriminating graft failure (C statistic, 0.76 versus 0.58). Clinical follow‐up (3.6 years, interquartile range [3.3–4.1]) was accomplished in 405 patients, and the rate of major adverse cardiac and cerebrovascular events was significantly higher among patients with functionally nonsignificant LAD arteries (10.1% versus 4.2%; adjusted hazard ratio, 3.08 [95% CI, 1.18–8.06]; P=0.022). Conclusions In patients receiving internal mammary artery to LAD artery coronary artery bypass grafting, preoperative QFR of the LAD artery of >0.80 was associated with a higher graft failure rate at 1 year and worse patient outcomes at the 3.6‐year follow‐up. |
| first_indexed | 2024-03-13T07:04:09Z |
| format | Article |
| id | doaj.art-2b83b6dbd1fc494d995db5e5c5328785 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T07:04:09Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2b83b6dbd1fc494d995db5e5c53287852023-06-06T12:15:47ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-06-01121110.1161/JAHA.122.029134Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass GraftingChunyuan Wang0Zhan Hu1Zhihui Hou2Yang Wang3Lei Song4Bo Xu5Changdong Guan6Yu Ning7Wei Feng8Yan Zhang9Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaMedical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaBackground In coronary artery bypass grafting, grafting a target vessel with nonsignificant stenosis increases the risk of graft failure. The present study aims to investigate the impact of preoperative quantitative flow ratio (QFR), a novel functional assessment of the coronary artery, on internal mammary artery graft failure rate and midterm patient outcomes. Methods and Results Between January 2016 and January 2020, we retrospectively included 419 patients who underwent coronary artery bypass grafting who had received preoperative angiography and postoperative coronary computed tomographic angiography in our center. QFR of the left anterior descending (LAD) artery was computed based on preoperative angiograms. The primary end point was the failure of the graft on the LAD artery assessed by coronary computed tomographic angiography at 1 year, and the secondary end point was major adverse cardiac and cerebrovascular events including death from any cause, myocardial infarction, stroke, or repeat revascularization. Grafts on functionally nonsignificant LAD arteries (QFR >0.80) had a significantly higher failure rate than those on functionally significant LAD arteries (31.4% versus 7.2%, P<0.001). QFR outperforms degree of stenosis in discriminating graft failure (C statistic, 0.76 versus 0.58). Clinical follow‐up (3.6 years, interquartile range [3.3–4.1]) was accomplished in 405 patients, and the rate of major adverse cardiac and cerebrovascular events was significantly higher among patients with functionally nonsignificant LAD arteries (10.1% versus 4.2%; adjusted hazard ratio, 3.08 [95% CI, 1.18–8.06]; P=0.022). Conclusions In patients receiving internal mammary artery to LAD artery coronary artery bypass grafting, preoperative QFR of the LAD artery of >0.80 was associated with a higher graft failure rate at 1 year and worse patient outcomes at the 3.6‐year follow‐up.https://www.ahajournals.org/doi/10.1161/JAHA.122.029134coronary artery bypass graftinggraft failureinternal mammary arteryquantitative flow ratio |
| spellingShingle | Chunyuan Wang Zhan Hu Zhihui Hou Yang Wang Lei Song Bo Xu Changdong Guan Yu Ning Wei Feng Yan Zhang Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary artery bypass grafting graft failure internal mammary artery quantitative flow ratio |
| title | Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting |
| title_full | Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting |
| title_fullStr | Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting |
| title_full_unstemmed | Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting |
| title_short | Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting |
| title_sort | impact of preoperative quantitative flow ratio of the left anterior descending artery on internal mammary artery graft patency and midterm patient outcomes after coronary artery bypass grafting |
| topic | coronary artery bypass grafting graft failure internal mammary artery quantitative flow ratio |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.029134 |
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