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Background <p>Coronary artery bypass grafting (CABG) is a key treatment for complex coronary artery disease, but graft occlusion can impact patient outcomes. Competitive flow from native coronary arteries is a known predictor of graft failure. While pressure-derived fractional flow reserve (FFR) guides percutaneous coronary interventions, its role in CABG planning remains unclear. Angiography-derived vessel FFR (vFFR) offers a non-invasive alternative, but its utility prior to CABG has not been well studied.</p> Methods <p>We retrospectively analysed 79 patients undergoing CABG between 2005 and 2014, with pre- and post-CABG angiograms. vFFR was calculated for all major native vessels. The primary endpoint was graft occlusion; the secondary endpoint was all-cause mortality.</p> Results <p>Among 132 grafts (93 arterial, 39 venous), preoperative vFFR predicted graft occlusion with an area under the curve of 0.85 (95% CI 0.75–0.94; p &lt; 0.001). A threshold of 0.75 yielded 90% sensitivity and 72% specificity. Occluded grafts had higher vFFR values than patent ones (0.78 [IQR 0.63–0.93] vs. 0.57 [IQR 0.35–0.79; p &lt; 0.001). In a univariate analysis, each 0.1-unit increase in vFFR was linked to a 2.78-fold higher risk of graft occlusion (95% CI 1.76–4.89; p &lt; 0.001). Graft occlusion did not correlate with all-cause mortality (46.2% occluded vs. 43.8% non-occluded group, <i>p </i>= 0.84) after a median follow-up of 10.7&#xa0;years.</p> Conclusions <p>Preoperative angiography-derived vFFR can accurately predict graft occlusion after CABG, with higher vFFR values indicating greater risk. Graft occlusion was not associated with increased long-term mortality.</p> Graphical Abstract <p></p>

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Angiography-derived fractional flow reserve in predicting graft occlusions prior to bypass surgery

  • 期刊论文

  • 发表日期：

    2025年11月17日

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  • Maria Buske,
  • Natalie Fischer,
  • Tobias Kister,
  • Markus Scholz,
  • Sylvia Henger,
  • Steffen Desch,
  • Holger Thiele,
  • Nicolas Majunke

摘要

Background

Coronary artery bypass grafting (CABG) is a key treatment for complex coronary artery disease, but graft occlusion can impact patient outcomes. Competitive flow from native coronary arteries is a known predictor of graft failure. While pressure-derived fractional flow reserve (FFR) guides percutaneous coronary interventions, its role in CABG planning remains unclear. Angiography-derived vessel FFR (vFFR) offers a non-invasive alternative, but its utility prior to CABG has not been well studied.

Methods

We retrospectively analysed 79 patients undergoing CABG between 2005 and 2014, with pre- and post-CABG angiograms. vFFR was calculated for all major native vessels. The primary endpoint was graft occlusion; the secondary endpoint was all-cause mortality.

Results

Among 132 grafts (93 arterial, 39 venous), preoperative vFFR predicted graft occlusion with an area under the curve of 0.85 (95% CI 0.75–0.94; p < 0.001). A threshold of 0.75 yielded 90% sensitivity and 72% specificity. Occluded grafts had higher vFFR values than patent ones (0.78 [IQR 0.63–0.93] vs. 0.57 [IQR 0.35–0.79; p < 0.001). In a univariate analysis, each 0.1-unit increase in vFFR was linked to a 2.78-fold higher risk of graft occlusion (95% CI 1.76–4.89; p < 0.001). Graft occlusion did not correlate with all-cause mortality (46.2% occluded vs. 43.8% non-occluded group, p = 0.84) after a median follow-up of 10.7 years.

Conclusions

Preoperative angiography-derived vFFR can accurately predict graft occlusion after CABG, with higher vFFR values indicating greater risk. Graft occlusion was not associated with increased long-term mortality.

Graphical Abstract