Bypass Grafting and Native Coronary Artery Disease Activity

Jacek Kwiecinski, Evangelos Tzolos, Alexander J Fletcher , Jennifer Nash, Mohammed N Meah, Sebastien Cadet, Philip D Adamson, Kajetan Grodecki, Nikhil Joshi, Michelle C Williams, Edwin J R van Beek, Chi Lai , Adriana A S Tavares, Mark G. MacAskill, Damini Dey, Andrew H Baker, Jonathon Leipsic, Daniel S. Berman, Stephanie L Sellers, David E NewbyMarc R Dweck, Piotr J Slomka*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: As well as developing graft vasculopathy, coronary artery bypass grafts (CABG) have been proposed to accelerate native coronary atherosclerosis. We aimed to describe the potential of 18F-sodium fluoride positron emission tomography (18F-NaF PET) to identify graft vasculopathy and to investigate the influence of CABG surgery on native coronary artery disease activity and progression.
Methods: Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary CT angiography, and one-year repeat coronary artery calcium scoring. We quantified the whole-vessel 18F-NaF PET coronary microcalcification activity (CMA) and change in calcium scores in those with and without CABG surgery.
Results: Among 293 participants (65±9 years; 84% male), 48 (16%) had CABG surgery 2.7 [1.4-10.4] years previously. Although all arterial and the majority (120/128, 94%) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA.
Bypassed native coronary arteries had 3-times higher CMA values (2.1 (0.4-7.5) versus 0.6 (0-2.7), p<0.001) and greater progression of one-year calcium scores (118 [48-194] versus 69 [21-142] AU, p=0.01) compared to those who that had not undergone CABG: an effect largely confined to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [0.4-7.5] vs 0.8 [0.3-3.2], p<0.001) and faster disease progression (24 [16-43] versus 8 [0-24] %, p=0.002) than matched patients (n=48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting.
Conclusions: Native coronary arteries that have been bypassed, demonstrate increased disease activity and more rapid disease progression than non-bypassed arteries, an observation that appears independent of the baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.
Original languageEnglish
JournalJACC: Cardiovascular Imaging
Publication statusPublished - 16 Feb 2022


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