Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the PREVENT IV Trial [1]
PREVENT IV trial participants who had undergone either a RIMA or LIMA to LAD anastomosis and underwent an angiogram at 1 to 1.5 years (n=1539) were analyzed for mammary graft failure (defined as >75% stenosis). Mammary graft failure occurred in 8.6% of patients, and independent predictors of graft failure were an LAD stenosis < 75% and the presence of a graft to the diagonal. These associations suggest competitive flow may play an important role in mammary graft failure and raise the question of whether LAD stenoses < 75% without evidence of ischemia should be bypassed and whether diagonal grafts should be more selectively performed.