Prognostic factors for atherosclerosis progression in saphenous vein grafts - The postcoronary artery bypass graft (post-CABG) trial

OBJECTIVES The study was done to assess patients in the Post-Coronary Arter y Bypass Graft (Post-CABG) trial to determine prognostic factors for athero sclerosis progression. BACKGROUND Saphenous vein grafts (SVGs) are effective in relieving angina a nd, in certain patient subsets, in prolonging life. However, the progressio n of atherosclerosis in many of these grafts limits their usefulness. METHODS The Post-CABG trial studied moderate versus aggressive lipid-loweri ng and low-dose warfarin versus placebo in patients with a history of coron ary artery bypass surgery and found that more aggressive lipid lowering was effective in preventing progression of atherosclerosis in SVGs, but warfar in had no effect. Using variables measured at baseline, we sought the indep endent prognostic factors for atherosclerosis progression in SVGs, employin g the statistical method of generalized estimating equations with a logit-l ink function. RESULTS Twelve independent prognostic factors for atherosclerosis progressi on were found. In the order of their importance they were: maximum stenosis of the graft at baseline angiography; years post-SVG placement; the modera te low-density lipoprotein- cholesterol (LDL-C) lowering strategy; prior my ocardial infarction; high triglyceride level; small minimum graft diameter; low high-density lipoprotein-cholesterol (HDL-C); high LDL-C; high mean ar terial pressure; low ejection fraction; male gender; and current smoking. CONCLUSIONS This study identified Post-CABG patient and SVG characteristics associated with saphenous vein graft; atherosclerosis progression. These d ata provide a basis for rational risk factor management to prevent progress ion of SVG atherosclerosis. (C) 2000 by the American College of Cardiology.