The association between coronary graft patency and clinical status in patients with coronary artery disease Mario Gaudino 1*, Antonino Di Franco 1, Deepak L. Bhatt 2, John H. Alexander 3, Antonio Abbate4, Lorenzo Azzalini 5, Sigrid Sandner 6, Garima Sharma 7, Sunil V. Rao 3, Filippo Crea 8, Stephen E. Fremes 9, and Sripal Bangalore 10 1 Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA; 2 Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 70 Francis St, Boston, MA 02115, USA; 3 Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA; 4 Division of Cardiology, VCU Pauley Heart Center and Wright Center for Clinical and Translational Research, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23219, USA; 5 Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23219, USA; 6 Department of Cardiac Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; 7 Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA; 8 Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, Roma 00168, Italy; 9 Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; and 10 Division of Cardiology, NYU Langone Health, 27 W 86th St, New York, NY 10024, USA Corresponding author. Tel: +1 212 746 9440, Fax: +1 212 746 8080, Email: [email protected] The concept of a direct association between coronary graft patency and clinical status is generally accepted. However, the relationship is more complex and variable than usually thought. Key issues are the lack of a common definition of graft occlusion and of a standardized imaging protocol for patients undergoing coronary bypass surgery. Factors like the type of graft, the timing of the occlusion, and the amount of myocardium at risk, as well as baseline patients’ characteristics, modulate the patency-to-clinical status association. Available evidence suggests that graft occlusion is more often associated with non-fatal events rather than death. Also, graft failure due to competitive flow is generally a benign event, while graft occlusion in a graft-dependent circulation is associated with clinical symptoms. In this systematic review, we summarize the evidence on the association between graft status and clinical outcomes. Variablesmodulating the interaction between graft occlusion and clinical status. Keywords Patency • CABG • Graft failure