Long-term Follow-up of Coronary Artery Bypass Patients With Preoperative and New Postoperative Native Coronary Artery Chronic Total Occlusion

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• 作者：David Pereg ; MD^a ; Paul Fefer ; MD^a ; ^b ; Michelle Samuel ; MPH^a ; Mony Shuvy ; MD^a ; Saswata Deb ; MD^c ; John D. Sparkes ; MSc^a ; Stephan E. Fremes ; MD ; FACC^c ; ^d ; Bradley H. Strauss ; MD ; PhD ; FACC^a ; ^e ; ^{bradley.strauss@sunnybrook.ca" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Canadian Journal of Cardiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：32
• 期：11
• 页码：1326-1331
• 全文大小：497 K

文摘

Chronic total occlusions (CTOs) of native coronary arteries are a frequent finding among patients who are referred for surgical revascularization with coronary artery bypass grafting (CABG). The long-term clinical significance of native coronary artery CTO identified at baseline and 1 year after CABG is unknown.

<h4 id="absSec_2">Methodsh4>

All patients who underwent 1-year follow-up angiography as part of the multicentre Radial Artery Patency Study (RAPS) were assessed for late clinical events.

<h4 id="absSec_3">Resultsh4>

At a mean follow-up of 7.3 ± 2.9 years, the study group of 388 patients had the following outcomes: 39 (10%) deaths, 6 (1.5%) cases of nonfatal myocardial infarction, and 19 (4.9%) cases of percutaneous coronary intervention (PCI). CTO of ≥ 1 native coronary artery in the baseline preoperative coronary angiogram was demonstrated in 240 (61.9%) patients. The composite of all-cause death, nonfatal myocardial infarction, and PCI occurred significantly more often in patients with at least 1 preoperative CTO than in patients without a preoperative CTO (20% vs 11%; P = 0.048). A new native coronary artery CTO 1 year after surgery occurred in 169 (43.6%) patients. The composite of all-cause death, nonfatal myocardial infarction, and PCI occurred significantly more often in patients with a new CTO 1 year after CABG compared with those without a new CTO (21.3% vs 12.8%; P = 0.028).

<h4 id="absSec_4">Conclusionsh4>

In patients undergoing CABG, both preoperative CTOs and new CTOs that develop 1 year after surgery are associated with adverse long-term clinical outcomes.