Adult: Coronary| Volume 165, ISSUE 3, P1080-1089.e1, March 2023

Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study



      Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery.


      A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery.


      Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P = .008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P = .001, respectively).


      In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      CABG (coronary artery bypass grafting), CI (confidence interval), COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies), CTA (computed tomography angiography), LAD (left anterior descending artery), LIMA (left internal mammary artery), OR (odds ratio), PREVENT (Project of Ex-Vivo Vein Graft Engineering via Transfection), RA (radial artery), RIMA (right internal mammary artery), ROOBY (Randomized On/Off Bypass), SV (saphenous vein)
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      Linked Article

      • Multiple and total arterial grafts are not a mirage anymore!
        JTCVS OpenVol. 13
        • Preview
          The use of single arterial graft (SAG) is the most used technique for coronary artery bypass grafting (CABG), although a body of literature reports an increasing use of multiple (MAG) and total arterial graft (TAG).1,2 Unfortunately, the use of MAG/TAG is still underused, being reported between 10% and 35% in Europe and North America.3 Factors such as higher consuming time, greater prone to spasm, and technical harvesting lead surgeons to prefer SAG to MAG/TAG (Figure 1). In addition, the latest guidelines encourage percutaneous coronary intervention in 3-vessel coronary artery disease patients with limited coronary calcification and favor the use of CABG in patients with extensive coronary calcifications.
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      • Commentary: Conduit selection in the COMPASS trial: Pointing in the wrong direction?
        The Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 3
        • Preview
          The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) investigators report 1-year computed tomography angiography patency rates of 4 different coronary artery bypass graft conduits.1 In the overall study, 1068 patients received 3480 grafts, or an average of 3.3 grafts per patient.1 The operations were performed by more than 100 surgeons in 83 centers in 22 countries.1 Overall, there were 2239 saphenous vein grafts (SVGs) (64%), 1068 left internal thoracic artery (LITA) grafts (31%), 90 radial artery (RA) grafts (2.6%), and 82 right internal thoracic artery (RITA) grafts (2.4%).
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