Effect of enhanced external counterpulsation on saphenous vein graft patency in patients undergoing coronary artery bypass grafting

Abstract Purpose : 10-20% of saphenous vein grafts (SVGs) occlude within the first year after coronary artery bypass grafting (CABG). Enhanced external counterpulsation (EECP) is a noninvasive therapy that improves coronary perfusion, reduces cardiac workload, and may attenuate neointimal hyperplasia and atherosclerosis. This study aimed to investigate the effect of EECP on SVG patency following CABG. Methods: Patients undergoing isolated CABG between January 2017 and June 2023 were retrospectively enrolled. The EECP protocol included 35 one-hour sessions, initiated three months postoperatively. The primary outcome was SVG occlusion at one year, assessed by computed tomography angiography. Secondary outcomes included SVG occlusion at two years, stroke, heart failure, coronary revascularization, and recurrent angina. Propensity score matching (PSM), logistic regression, and Kaplan-Meier analysis were used to assess EECP's effects at both per-patient and per-graft levels. Results: A total of 145 patients were included, with 39 patients undergoing EECP. After PSM, the EECP group showed a lower incidence of SVG occlusion than controls in per-patient (1-year OR 0.325, 95% CI 0.102–0.931; 2-year OR 0.296, 95% CI 0.088–0.916) and per-graft (1-year OR 0.336, 95% CI 0.137–0.768; 2-year OR 0.232, 95% CI 0.084–0.58). Kaplan-Meier analysis confirmed these results after PSM (per patient: hazard ratio [HR] 0.245, 95% CI 0.074–0.808; per graft: HR 0.384, 95% CI 0.176–0.839). No significant differences were observed in stroke, heart failure, coronary revascularization, or recurrent angina. Conclusions: EECP was associated with a lower risk of SVG occlusion after CABG, suggesting it may be a valuable adjunct to optimize SVG patency and improve long-term outcomes. Trial registration: ClinicalTrials.gov; NCT03235323. Registration date, 2017/09/05, "retrospectively registered".