PROGRESSION OF ATHEROSCLEROSIS AFTER VENOUS CORONARY-ARTERY BYPASS GRAFT-SURGERY - A 15-YEAR FOLLOW-UP-STUDY

We investigated the influence of progression of atherosclerosis on cli nical outcome in a cohort of 428 consecutive patients with isolated ve nous coronary artery bypass graft surgery followed prospectively for 1 5 years, In 189 patients 307 repeat coronary angiograms were performed because of recurrent signs of ischemia. Progression in the native cor onary circulation only was found in 38 angiograms (12%), in both the n ative circulation and in venous grafts in 66 angiograms (21%), in veno us grafts only in 135 angiograms (44%), and no progression was found i n 68 angiograms (22%). In all the angiographies with a proven progress ion in the native coronary arteries, 40% was found to be distal to a v ein graft insertion, In multivariate analysis the number of distal ana stomoses predicts progression in both the native circulation and in ve nous grafts. Thus, progression is determined by the extensiveness of c oronary artery disease at operation, Also, the interval between operat ion and repeat angiography predicts progression in the native circulat ion. We conclude that clinical outcome is also determined by progressi on in the native coronary circulation, Secondary prevention may, there fore, benefit not only the longterm result in patients with venous byp ass grafts but probably also in patients with any type of coronary byp ass surgery. (C) 1997 Wiley-Liss, Inc.