This single-center retrospective study evaluated whether stenosis in the intervening left anterior descending artery (iLAD), between the internal thoracic artery (ITA) anastomosis and diagonal bifurcation, affects ITA-LAD graft events after coronary artery bypass grafting (CABG).
Among 496 patients with ITA-LAD and diagonal grafts, 161 had nonsevere iLAD stenosis (<90 percent) and 335 had severe stenosis (≥90 percent). With a median follow-up of 6.8 years, the 10-year freedom from ITA-LAD events was lower in the nonsevere group vs the severe iLAD stenosis group (89.5 percent ± 2.8 percent vs 97.2 percent ± 1.0 percent; p=0.002). Nonsevere iLAD stenosis (HR 2.59; p=0.035) and individual diagonal grafting (HR 2.57; p=0.041) were independently predicted events. The authors conclude that iLAD-tailored grafting, including sequential diagonal grafting, may improve long term ITA-LAD patency.
