Distal Vessel Quality Score as a Predictor of Graft Patency after Aorto-Coronary Bypass Graft: Towards the Optimization of the Revascularization Strategy

Aims: We aimed to develop a new simple angiographic score that would predict short- and mid-term patency problems of coronary artery bypass grafts (CABG).

Methods: We enrolled 249 patients who underwent CABG. The Distal Vessel Quality (DVQ) score was calculated according to 1/visibility, 2/diameter, and 3/size of the distal vessel as angiographically evaluated at baseline. Each variable was quantified from 0 (worst) to 3 (best) and the DVQ score resulted from the addition of these values.

Results: At 5-year of follow-up 16% of the patients had been admitted due to a coronary event and, after angiography, occlusion of 67 grafts (9.2%) was demonstrated (median time from surgery: 1.4 [IQR: 0.5-1.7] years). In 67% of the cases, a diseased graft was the responsible for the event. Venous grafts were 2.5 times more frequently occluded than arterial grafts (p=0.098). Indeed, the use of arterial grafts (OR=0.217, 95% CI [0.064-0.737], p=0.014) and higher values of DVQ score (OR=0.555, 95% CI [0.370-0.832], p=0.004) were independent predictors of bypass graft patency at 5-year follow-up. To remark, bad correlation of DVQ and syntax scores was found (R=0.228) and the last failed to predict the risk of early graft malfunction.

Conclusions: The DVQ score is a new simple tool that may help to predict outcomes of coronary bypass grafts. Lower values of this score suggest limited benefit of bypass grafting. Therefore, the DVQ score could help to improve outcomes of cardiac surgery by improving the selection of patients. External validation of these results is warranted.

Author(s):

Héctor Cubero-Gallego, Ignacio J Amat-Santos, Sandra Llerena, Pablo E García-Granja, Carlos Cortés, Javier Castrodeza, Hipólito Gutiérrez, Benigno Ramos, Roman Arnold, Salvatore Di Stefano, Itziar Gómez and José-Alberto San-Román

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