David Pereg1, Paul Fefer2, Michelle Samuel1, Rafael Wolff1, Andrew Czarnecki1, Saswata Deb3, John D Sparkes1, Stephan E Fremes4, Bradley H Strauss5. 1. Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 2. Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel. 3. Division of Cardiovascular Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 4. Division of Cardiovascular Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bernard S. Goldman Chair in Cardiovascular Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. 5. Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Reichmann Chair in Cardiovascular Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. Electronic address: Bradley.strauss@sunnybrook.ca.
Abstract
OBJECTIVES: The aim of the study was to determine native coronary artery patency 1 year after coronary artery bypass grafting and to identify clinical and angiographic predictors for the development of a chronic total occlusion (CTO). BACKGROUND: In contrast to the large body of information regarding graft patency, data regarding atherosclerosis progression and vessel patency in surgically bypassed native coronary arteries are less clear. METHODS: Of the 440 patients who underwent 1-year follow-up angiography as part of the multicenter RAPS (Radial Artery Patency Study), included in our study were 388 patients (88%) for whom angiograms were available for review. Angiograms were reviewed for native coronary artery patency in an independent blinded manner. RESULTS: On the pre-operative angiogram, CTO of at least 1 native coronary vessel was demonstrated in 240 patients (61.9%) having 305 occluded vessels. At 1 year after coronary artery bypass grafting, at least 1 new native coronary artery CTO occurred in 169 patients (43.6%). In 7.5% of patients, the native artery and the graft supplying that territory were both occluded. A new CTO was almost 5 times more likely to occur in coronary vessels with a pre-operative proximal stenosis >90% compared with vessels with proximal stenosis <90% (45.5% vs. 9.5%, respectively, p < 0.001). Patients with a new CTO had significantly more baseline Canadian Cardiovascular Society class 4 angina compared with patients without a new CTO. A new CTO was less likely to occur in the left anterior descending artery (18.4%), supplied by the left internal thoracic artery. When comparing radial artery and saphenous vein grafts, neither the type of graft nor graft patency had any association with native coronary artery occlusion. CONCLUSIONS: CTO of surgically bypassed coronary arteries 1 year after coronary artery bypass grafting is extremely common.
RCT Entities:
OBJECTIVES: The aim of the study was to determine native coronary artery patency 1 year after coronary artery bypass grafting and to identify clinical and angiographic predictors for the development of a chronic total occlusion (CTO). BACKGROUND: In contrast to the large body of information regarding graft patency, data regarding atherosclerosis progression and vessel patency in surgically bypassed native coronary arteries are less clear. METHODS: Of the 440 patients who underwent 1-year follow-up angiography as part of the multicenter RAPS (Radial Artery Patency Study), included in our study were 388 patients (88%) for whom angiograms were available for review. Angiograms were reviewed for native coronary artery patency in an independent blinded manner. RESULTS: On the pre-operative angiogram, CTO of at least 1 native coronary vessel was demonstrated in 240 patients (61.9%) having 305 occluded vessels. At 1 year after coronary artery bypass grafting, at least 1 new native coronary artery CTO occurred in 169 patients (43.6%). In 7.5% of patients, the native artery and the graft supplying that territory were both occluded. A new CTO was almost 5 times more likely to occur in coronary vessels with a pre-operative proximal stenosis >90% compared with vessels with proximal stenosis <90% (45.5% vs. 9.5%, respectively, p < 0.001). Patients with a new CTO had significantly more baseline Canadian Cardiovascular Society class 4 angina compared with patients without a new CTO. A new CTO was less likely to occur in the left anterior descending artery (18.4%), supplied by the left internal thoracic artery. When comparing radial artery and saphenous vein grafts, neither the type of graft nor graft patency had any association with native coronary artery occlusion. CONCLUSIONS:CTO of surgically bypassed coronary arteries 1 year after coronary artery bypass grafting is extremely common.
Authors: Frans J Beerkens; Bimmer E Claessen; Marielle Mahan; Mario F L Gaudino; Derrick Y Tam; José P S Henriques; Roxana Mehran; George D Dangas Journal: Nat Rev Cardiol Date: 2021-10-05 Impact factor: 32.419
Authors: Andreas Seraphim; Benjamin Dowsing; Krishnaraj S Rathod; Hunain Shiwani; Kush Patel; Kristopher D Knott; Sameer Zaman; Ieuan Johns; Yousuf Razvi; Rishi Patel; Hui Xue; Daniel A Jones; Marianna Fontana; Graham Cole; Rakesh Uppal; Rhodri Davies; James C Moon; Peter Kellman; Charlotte Manisty Journal: J Am Coll Cardiol Date: 2022-03-29 Impact factor: 27.203
Authors: Rami M Abazid; Jonathan G Romsa; Cigdem Akincioglu; James C Warrington; Yves Bureau; Bob Kiaii; William C Vezina Journal: Open Heart Date: 2021-06
Authors: Andreas Seraphim; Kristopher D Knott; Anne-Marie Beirne; Joao B Augusto; Katia Menacho; Jessica Artico; George Joy; Rebecca Hughes; Anish N Bhuva; Ryo Torii; Hui Xue; Thomas A Treibel; Rhodri Davies; James C Moon; Daniel A Jones; Peter Kellman; Charlotte Manisty Journal: J Cardiovasc Magn Reson Date: 2021-06-17 Impact factor: 5.364