Progression of atherosclerosis after venous coronary artery bypass graft surgery: a 15-year follow-up study.

We investigated the influence of progression of atherosclerosis on clinical outcome in a cohort of 428 consecutive patients with isolated venous coronary artery bypass graft surgery followed prospectively for 15 years. In 189 patients 307 repeat coronary angiograms were performed because of recurrent signs of ischemia. Progression in the native coronary circulation only was found in 38 angiograms (12%), in both the native circulation and in venous grafts in 66 angiograms (21%), in venous grafts only in 135 angiograms (44%), and no progression was found in 68 angiograms (22%). In all the angiographies with a proven progression in the native coronary arteries, 40% was found to be distal to a vein graft insertion. In multivariate analysis the number of distal anastomoses predicts progression in both the native circulation and in venous grafts. Thus, progression is determined by the extensiveness of coronary artery disease at operation. Also, the interval between operation and repeat angiography predicts progression in the native circulation. We conclude that clinical outcome is also determined by progression in the native coronary circulation. Secondary prevention may, therefore, benefit not only the long-term result in patients with venous bypass grafts but probably also in patients with any type of coronary bypass surgery.