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Risk factors of graft thrombosis in patients with coronary artery disease in the long term after coronary artery bypass grafting

Authors: Kubova М.Ch., Bulaeva N.I., Ruzina E.V., Golukhova Е.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2021-15-2-180-193

For citation: Kubova М.Ch., Bulaeva N.I., Ruzina E.V., Golukhova Е.Z. Risk factors of graft thrombosis in patients with coronary artery disease in the long term after coronary artery bypass grafting. Creative Cardiology. 2021; 15 (2): 180–93 (in Russ.). DOI: 10.24022/1997-3187-2021-15-2-180-193

Received / Accepted:  01.06.2021 / 25.06.2021

Keywords: coronary artery bypass grafting coronary artery disease myocardial revascularization

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Abstract

Objectives. To identify the predictors of graft failure after 6–12 months after coronary artery bypass grafting (CABG).

Material and methods. This is a prospective, observational, single-center, cohort study. We examined 127 patients who underwent CABG. The 98 (77%) patients underwent angiography in 6–12 months post-CABG.

Results. Only 9 (9.2%) patients had venous grafts failure (VGF) (stenosis ≥75% or occlusion) in late postoperative period. There were no signs of arterial conduits failure. The VGF in long-term period was associated with a history of myocardial infarction (relative risk (RR) 1.01; 0.55–1.85), stroke (RR 2.15; 0.29–15 , 96), diabetes mellitus (RR 1.16; 0.9–1.49), multivessel coronary lesions (RR 1.13; 0.78–1.63). Patients with VGF had higher levels of type 1 plasminogen activator inhibitor (p=0.0012), antithrombin-III (p=0.0192), P-selectin (p=0.0001), C-reactive protein (p=0.0001), interleukin-6 (p=0.0001) early after surgery (1–7 days). Higher levels of platelet aggregation before discharge (p=0.0745) and at late follow-up period (p=0.045); higher total cholesterol values late after CABG (p=0.06) compared with patients without VGF. Univariate regression analysis revealed critical values of the degree of platelet aggregation with 5 μM adenosine diphosphate (ADP) with a significant effect on the development of VGF at 7th day after surgery 34.5% (AUC 0.574; 95% confidence interval (CI) 0.463–0.686; p=0.0126) and 6–12 months after surgery 51.5% (AUC 0.626; 95% CI 0.38–0.872; p=0.0253).

Conclusions. The VGF after CABG is associated with a higher level of inflammation in the early postoperative period, insufficient suppression of platelet aggregation activity, and unsatisfactory correction of the lipid profile. A history of diabetes mellitus, myocardial infarction and stroke also increases the risk of VGF.

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About Authors

  • Maida Ch. Kubova, Researcher, Cardiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Senior Researcher, Cardiologist; ORCID
  • Evgenia V. Ruzina, Cardiologist; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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