Impact of Left Internal Mammary Artery-to-Left Anterior Descending Artery Anastomotic Location on Graft Patency: A Secondary Analysis of the PATENCY Trial Data Set.
Chunyuan Wang, Meice Tian, Yang Wang et al.
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In 30 seconds
This secondary analysis of the PATENCY trial data set examined whether the location of the left internal mammary artery (LIMA)-to-left anterior descending artery (LAD) anastomosis was associated with graft patency in 1597 patients with isolated proximal LAD lesions undergoing coronary artery bypass grafting. Using postoperative coronary CT angiography, investigators classified anastomoses as distal or proximal around an exploratory 46% threshold. At 3 years, LIMA occlusion was lower with distal anastomosis than proximal anastomosis (2.3% versus 6.3%; adjusted odds ratio, 0.37 [95% CI, 0.20-0.68]; P =0.002). Major adverse cardiac event rates were similar.
Key findings
- Distal anastomosis (RAS >46%) was associated with lower 3-year LIMA occlusion than proximal anastomosis (RAS ≤46%): 2.3% versus 6.3%.
- The adjusted odds ratio for 3-year LIMA occlusion with distal versus proximal anastomosis was 0.37 [95% CI, 0.20-0.68]; P =0.002.
- Three-year major adverse cardiac event rates were similar: 3.4% versus 4.4%; adjusted hazard ratio, 0.68 [95% CI, 0.40-1.15]; P =0.16.
Why it matters
LIMA graft occlusion is an important postoperative outcome, and these findings suggest that anastomotic location may be associated with graft patency in patients with isolated proximal LAD disease. The absence of a significant difference in major adverse cardiac events means the patency finding should not be assumed to translate into a demonstrated clinical-event benefit.
What to keep in mind
This was a secondary analysis, and the 46% RAS threshold was exploratory. The authors state that prospective validation is warranted.