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Canadian Journal of Cardiology

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

Published:January 21, 2016DOI:https://doi.org/10.1016/j.cjca.2016.01.015

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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).

      Conclusions

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

      Résumé

      Introduction

      Les occlusions totales chroniques (OTC) des artères coronaires natives sont fréquemment découvertes chez les patients qui sont orientés pour subir une revascularisation par pontage aortocoronarien (PAC). On ignore la signification clinique à long terme de l’OTC au début et 1 an après le PAC.

      Méthodes

      Nous avons évalué les événements cliniques tardifs de tous les patients qui subissaient une angiographie de suivi après 1 an dans le cadre de l’étude multicentrique RAPS (Radial Artery Patency Study).

      Résultats

      Au suivi moyen de 7,3 ± 2,9 ans, le groupe expérimental de 388 patients ont montré les résultats cliniques suivants : 39 (10 %) décès, 6 (1,5 %) cas d'infarctus du myocarde non fatal et 19 (4,9 %) cas d'intervention coronarienne percutanée (ICP). Deux cent quarante (61,9 %) patients avaient démontré une OTC de ≥ 1 artère coronaire native à l'angiographie préopératoire initiale. Le critère composite de la mortalité toutes causes confondues, d'infarctus du myocarde non fatal et d’ICP est apparu significativement plus souvent chez les patients ayant au moins 1 OTC avant la chirurgie (20 % vs 11 %; P = 0,048). Une nouvelle OTC de l'artère coronaire native 1 an après la chirurgie est apparue chez 169 (43,6 %) patients. Le critère composite de la mortalité toutes causes confondues, d'infarctus du myocarde non fatal et d’ICP est apparu significativement plus souvent chez les patients ayant une nouvelle OTC 1 an après le PAC comparativement à ceux n'ayant pas eu de nouvelle OTC (21,3 % vs 12,8 %; P = 0,028).

      Conclusions

      Chez les patients subissant un PAC, l’OTC avant la chirurgie et la nouvelle OTC qu'ils développaient 1 an après la chirurgie sont associées à des résultats cliniques défavorables à long terme.
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