JTCVS Open. 2026 May 4;32:101837. doi: 10.1016/j.xjon.2026.101837. eCollection 2026 Aug.
ABSTRACT
OBJECTIVE: The study objective was to evaluate stenosis severity influence in the intervening left anterior descending artery, between the internal thoracic artery anastomosis and the diagonal branch bifurcation, on internal thoracic artery left anterior descending graft events in patients undergoing coronary artery bypass grafting.
METHODS: We analyzed 496 patients undergoing primary coronary artery bypass grafting with internal thoracic artery left anterior descending and diagonal grafts. Stratified analysis was based on intervening left anterior descending artery stenosis severity (nonsevere <90%, n = 161; severe ≥90%, n = 335). The primary end point was freedom from internal thoracic artery left anterior descending events (composite of myocardial infarction, reintervention, and occlusion/string sign). Median follow-up was 6.8 years.
RESULTS: The nonsevere group was younger, with more left main disease, but fewer sequential grafts (P = .002, .035, .008, respectively). Freedom from internal thoracic artery left anterior descending events at 1, 5, and 10 years was lower in the nonsevere group (94.3% ± 1.8%, 92.9% ± 2.1%, 89.5% ± 2.8%, respectively) versus the severe group (99.1% ± 0.5%, 97.2% ± 1.0%, 97.2% ± 1.0%, respectively; log-rank P = .002). Proximal left anterior descending and diagonal stenoses did not affect internal thoracic artery left anterior descending events (log-rank P = .399, .391, respectively). Sequential diagonal grafting reduced internal thoracic artery left anterior descending events compared with individual grafting (log-rank P = .005). Multivariable analysis identified nonsevere intervening left anterior descending artery stenosis (hazard ratio, 2.59; 95% CI, 1.07-6.30; P = .035) and individual diagonal grafting (hazard ratio, 2.57; 95% CI, 1.04-6.36; P = .041) as independent risk factors, whereas higher internal thoracic artery left anterior descending flow (hazard ratio, 0.94; 95% CI, 0.90-0.98; P = .006) was a protective factor.
CONCLUSIONS: Nonsevere intervening left anterior descending artery stenosis independently predicted internal thoracic artery left anterior descending events. Sequential diagonal grafting significantly mitigated this risk. Thus, a grafting strategy considering intervening left anterior descending artery stenosis is essential to ensure long-term internal thoracic artery left anterior descending patency.
PMID:42604286 | PMC:PMC13476992 | DOI:10.1016/j.xjon.2026.101837