Predictors of Internal Mammary Artery Graft Failure

The Internal Mammary Artery (IMA) is the preferred conduit for bypassing the left anterior descending artery (LAD) in patients undergoing coronary artery bypass grafting. There is no systematic evaluation of the frequency and predictors of IMA failure or long-term outcomes.

The PREVENT IV included 1539 patients receiving IMA-LAD revascularization with 12 and 18 month follow up. Logistic regression was used to identify characteristics associated with IMA failure (≥75% stenosis) and itsconnectionwith clinical events such as death, myocardial infarction, and repeat revascularization.

IMA failure occurred in 132 patients (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (OR 1.76; CI 95% 1.19-2.59), additional bypass graft to diagonal branch (OR 1.92; CI 95% 1.33-2.76), and not having diabetes (OR 1.82; CI 95% 1.20-2.78).

IMA failure was associated with a higher incidence of AMI mostly due to a higher rate of repeat revascularization.

Conclusion
IMA failure is associated to clinical events and is observed mainly in patients with a prior intermediate LAD stenosis or with an additional bypass graft to a diagonal branch. This finding should be taken into account when indication surgery for patients with no functional evidence of ischemia in LAD territory.

Original Title: Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the PREVENT IV Trial. Reference: Ralf E. Harskamp et al. Circulation. 2015 Dec 8.Epub ahead of print.

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