Prognostic factors for atherosclerosis progression in saphenous vein grafts - The postcoronary artery bypass graft (post-CABG) trial

被引:92
作者
Domanski, MJ
Borkowf, CB
Campeau, L
Knatterud, GL
White, C
Hoogwerf, B
Rosenberg, Y
Geller, NL
机构
[1] NHLBI, Clin Trials Grp, Bethesda, MD 20892 USA
[2] NHLBI, Off Biostat Res, Bethesda, MD 20892 USA
[3] Maryland Med Res Inst, Baltimore, MD USA
[4] Univ Minnesota Hosp & Clin, Div Cardiol, Minneapolis, MN 55455 USA
[5] Cleveland Clin Fdn, Cleveland, OH 44195 USA
[6] Montreal Heart Inst, Dept Cardiol, Montreal, PQ H1T 1C8, Canada
关键词
D O I
10.1016/S0735-1097(00)00973-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The study was done to assess patients in the Post-Coronary Artery Bypass Graft (Post-CABG) trial to determine prognostic factors for atherosclerosis progression. BACKGROUND Saphenous vein grafts (SVGs) are effective in relieving angina and, in certain patient subsets, in prolonging life. However, the progression of atherosclerosis in many of these grafts limits their usefulness. METHODS The Post-CABG trial studied moderate versus aggressive lipid-lowering and low-dose warfarin versus placebo in patients with a history of coronary artery bypass surgery and found that more aggressive lipid lowering was effective in preventing progression of atherosclerosis in SVGs, but warfarin had no effect. Using variables measured at baseline, we sought the independent prognostic factors for atherosclerosis progression in SVGs, employing the statistical method of generalized estimating equations with a logit-link function. RESULTS Twelve independent prognostic factors for atherosclerosis progression were found. In the order of their importance they were: maximum stenosis of the graft at baseline angiography; years post-SVG placement; the moderate low-density lipoprotein- cholesterol (LDL-C) lowering strategy; prior myocardial infarction; high triglyceride level; small minimum graft diameter; low high-density lipoprotein-cholesterol (HDL-C); high LDL-C; high mean arterial pressure; low ejection fraction; male gender; and current smoking. CONCLUSIONS This study identified Post-CABG patient and SVG characteristics associated with saphenous vein graft; atherosclerosis progression. These data provide a basis for rational risk factor management to prevent progression of SVG atherosclerosis. (C) 2000 by the American College of Cardiology.
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页码:1877 / 1883
页数:7
相关论文
共 34 条
[1]  
Agresti A., 1990, CATEGORICAL DATA ANA, P59
[2]  
ATKINSON J, 1985, CHEST, V8, P341
[3]   Goodness-of-fit tests for GEE modeling with binary responses [J].
Barnhart, HX ;
Williamson, JM .
BIOMETRICS, 1998, 54 (02) :720-729
[4]   BENEFICIAL-EFFECTS OF COMBINED COLESTIPOL-NIACIN THERAPY ON CORONARY ATHEROSCLEROSIS AND CORONARY VENOUS BYPASS GRAFTS [J].
BLANKENHORN, DH ;
NESSIM, SA ;
JOHNSON, RL ;
SANMARCO, ME ;
AZEN, SP ;
CASHINHEMPHILL, L .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1987, 257 (23) :3233-3240
[5]   FATE OF VENOUS GRAFTS - THE PAST, THE PRESENT AND THE FUTURE [J].
BOURASSA, MG .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1991, 17 (05) :1081-1083
[6]   Aggressive cholesterol lowering delays saphenous vein graft atherosclerosis in women, the elderly, and patients with associated risk factors - NHLBI post coronary artery bypass graft clinical trial [J].
Campeau, L ;
Hunninghake, DB ;
Knatterud, GL ;
White, CW ;
Domanski, M ;
Forman, SA ;
Forrester, JS ;
Geller, NL ;
Gobel, FL ;
Herd, JA ;
Hoogwerf, BJ ;
Rosenberg, Y .
CIRCULATION, 1999, 99 (25) :3241-3247
[7]   THE RELATION OF RISK-FACTORS TO THE DEVELOPMENT OF ATHEROSCLEROSIS IN SAPHENOUS-VEIN BYPASS GRAFTS AND THE PROGRESSION OF DISEASE IN THE NATIVE CIRCULATION - A STUDY 10 YEARS AFTER AORTOCORONARY BYPASS-SURGERY [J].
CAMPEAU, L ;
ENJALBERT, M ;
LESPERANCE, J ;
BOURASSA, MG ;
KWITEROVICH, P ;
WACHOLDER, S ;
SNIDERMAN, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 311 (21) :1329-1332
[8]  
Campeau L, 1997, NEW ENGL J MED, V336, P153
[9]  
CAMPEAU L, 1983, CIRCULATION S
[10]   LONG-TERM ANGIOGRAPHIC FOLLOW-UP OF NORMAL AND MINIMALLY DISEASED SAPHENOUS-VEIN GRAFTS [J].
CAMPOS, EE ;
CINDERELLA, JA ;
FARHI, ER .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 21 (05) :1175-1180