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.
- 1Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- 2Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, Vienna, Austria.
Abstract
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. 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. 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). 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.
Related
- Association of hypertension, diabetes mellitus, and coronary artery disease with left ventricular ejection fraction and serum creatinine in patients with heart failure: An exploratory retrospective cross-sectional study
- Association of the triglyceride-glucose index and triglyceride-glucose-body mass index with postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study
- Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention
- Effectiveness of a voice-guided tap-and-talk educational tool in enhancing cardiovascular knowledge and self-management in aged patients following percutaneous coronary intervention.
- Prognostic Value of the Atherogenic Index of Plasma for Severity and Cardiovascular Outcomes in Young Patients (≤35 Years) with Coronary Artery Disease: A Retrospective Study
BibTeX
@article{qi2026association,
title = {{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.}},
author = {Zhaoxi Qi and Yunpeng Zhu and Xiaofeng Ye and Zhe Wang and Sigrid E Sandner and Yi Yang and Qiang Zhao},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1430},
url = {https://europepmc.org/article/MED/42996942},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Zhaoxi Qi
AU - Yunpeng Zhu
AU - Xiaofeng Ye
AU - Zhe Wang
AU - Sigrid E Sandner
AU - Yi Yang
AU - Qiang Zhao
PY - 2026
DA - 2026/09/28
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1430
UR - https://europepmc.org/article/MED/42996942
AB - 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. 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. 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). 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.
SN - 2072-1439
SN - 2077-6624
ER -