Solorio R, Montoya SA, Padilla F, López D, Ramírez H, Campos A, Valdez R, González B, Abundes Va, Estrada J, Astudillo R, Flores J, Garrido M, Farell CJ

Language: Spanish
References: 25
Page: 75-80
PDF size: 79.92 Kb.

ABSTRACT

Background: Despite coronary artery bypass graft (CABG), which exchanges long-term patient prognosis in terms of symptoms and mortality, the CABG has its lacks. Lost of trials proved a wide range of adverse events (20% to 30%) and a one year graft occlusion rate from 13% to 37%. The ischemia could be due to coronary artery disease progression or to graft occlusion. Objective: The study was designed to evaluate the major cardiac events (MACE) at 6 months and 1 year in patients with previous CABG and treated with percutaneous coronary intervention (PCI). Methods: A retrospective analysis of patients records with history of CABG and who underwent trough PCI between December 1996 and June 2001. We included all the patients with PCI in native coronary arteries, left mammary artery and venous graft. End-points were death, acute myocardial infarction, recurrence of angina, and repeated revascularization. Results: (OUTCOMES) We included 55 patient (5%) from a 1,100 patient registry with PCI between December 1996 and June 2001. The mean age was 61.6 ± 7.3 years old, 81% were male, 60% with history of hypertension, 31% with type 2 diabetes mellitus, 48% with high serum cholesterol levels and 56% with smoking history. The mean time we effectuated the PCI after the CABG was 76.4 months. The indications were: unstable angina 59.6%, chronic angina 39% and acute myocardial infarction 1.6%. We treated 99 obstructive lesions, 20 with balloon angioplasty and 79 with Stent. Classification of the lesions: B2 lesion 48.5%, B1 27.2% and C 24.2. We obtain immediate success in 92.7% of lesions. The mean follow up at 12.8 months showed 39 (70.9%) patients remained without symptoms. The last 16 patients (29.1%) with chronic angina in functional class II or III from the Canadian Cardiac Society. From 51 patients with immediate success, 19.6% showed angina at 12 months. The diabetic group showed increase rate of angina (35.2% vs 10.52%) at 12 months compared with non-diabetic patients. Related with vessel disease 38% of patients with 2 vessel disease showed angina in the follow up compared with 8% in patients with 1 vessel disease. Thirteen patients were evaluated with coronary angiography, 9 patients (70%) showed Stent without restenosis, nevertheless we found 30% with significant restenosis. Conclusions: This work showed similar outcomes to other clinical trials, with MACE close to 30%, best long term results in patients with immediate success and negative prognostic in diabetic group.

REFERENCES

1. CASS. Coronary Artery Surgery Study. Circulation 1983; 68: 939-50.

2. Campeau L, Lesperance J et al. Loss of improvement of angina between 1 and 7 years after aortocoronary bypass surgery. Circulation 1979; 60: 11-15.

3. Goldman S, Zadina K, Moritz T et al. Prospective ten years patency of saphenous vein and left internal mammary artery grafts coronary Bypass surgery. J Am Coll Cardiol 2001; 37(Suppl A): 1A-648A.

4. Weintraub WS, Jones EL et al. Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery. Circulation 1997; 95: 868-877.

5. Choussat R, Black AJ, Bossi et al. Diffusely Diseased Saphenous Vein Grafts Implanted to the Left Anterior Descending Coronary Artery. Wath is the Best Treatment Strategy? Circulation 2000: 102-18; 11-680.

6. De Feyter PJ, Van Suylen RJ et al. Ballon Angioplasty for the treatment of lesions in saphenous Vein bypass grafts. J Am Coll Cardiol 1993; 2: 1539-49.

7. Lefkovits J, Holmes DR et al. For the CAVEAT –II Investigators. Predictors and sequelae of distal embolization from the CAVEAT –II trial . Circulation 1995; 92: 734-740.

8. Reeves F, Bonan R et al. Long-term angiographic follow-up after angioplasty of venous coronary bypass grafts. Am Herat J 1991; 122: 620-27.

9. Piana RN, Moscucci M, Cohen DJ et al. Palmaz-Schatz stenting for treatment of local vein graft stenosis: immediate results and long-term outcome. J Am Coll Cardiol 1994; 23: 1296-1304.

10. Wong SC, Baim DS , Schatz RA et al. For the Palmaz-Schatz Stent Study Group. Immediate results and late outcome after Stent Implantation in saphenous vein graft lesions: the multicenter U.S. Palmaz-Schatz stent experience. J Am Coll Cardiol 1995; 26: 704-712.

11. Savage M, Douglas J et al. For the saphenous Vein De Novo Trial Investigators. Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. N Engl J Med 1997; 337: 740-747.

12. Hanekamp CEE, Koolen JJ et al. For the VENESTENT Study Group. A Randomized Comparison Between Balloons Angioplasty and elective Stent Implantation in Venous Bypass Graft; The VENESTENT Study. J Am Coll Cardiol 2000; 35: 9ª: 79-8.

13. Keeley EC, Velez CA et al. Long Term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts. J Am Coll Cardiol 2001; 38: 659-65.

14. Choussat R, Black AJ, Bossi I et al. Long-term clinical outcome after endoluminal Reconstruction of Diffusely Degenerated Saphenous Vein Grafts with Less-Shortening Wallstents. J Am Coll Cardiol 2000; 36-2: 387-395.

15. Le May MR, Albinas M et al. Predictors of long-term outcome after stent implantation in a saphenous vein graft. Am J Cardiol 1999; 83-5: 681-686.

16. Ahmed JM, Hong MK, Mehran R et al. Influence of Diabetes mellitus on early and late clinical outcomes in saphenous vein graft stenting. J Am Coll Cardiol 2000; 36: 1186-93.

17. Mak KH, Challapalli R, Eisenberg MJ, Anderson KM, Topol EJ, for the EPIC Investigators. Effect of Platelet Glycoprotein IIB/IIIa Receptor inhibition on Distal Embolization During Percutaneous Revascularization of Aortocoronary Saphenous Vein Grafts. Am J Cardiol 1997; 80: 985-988.

18. Ellis SG, Lincoff AM, Miller D et al. Reduction in complications of angioplasty with abciximab occurs largely independently of baseline lesion morphology. J Am Coll Cardiol 1998; 32: 1619-23.

19. Khan MA, Liu MW, Chio FL et al. Effect of abciximab on cardiac enzyme elevation after transluminal extraction atherectomy (TEC) in high risk saphenous vein graft lesions: comparison with a historical control group. Cath Cardiovasc Interv 2001; 52: 40-44.

20. Baims DS, Wahr DG et al. Randomized trial of distal embolic protection device during percutaneous intervention of saphenous vein aortocoronary bypass grafts. Circulations 2002; 105: 1285-90.

21. Baldus S, Koster R, Elsner M et al. Treatment of Aortocoronary Vein Graft Lesions With Membrane-Covered Stents: A multicenter Surveillance Trial. Circulation 2000; 102: 2024-2027.

22. Castagna MT, Mintz GS, Waksman R et al. Comparative efficacy of g-irradiation for treatment of in-Stent restenosis in saphenous vein graft versus native coronary artery in-stent restenosis. Circulation 2001; 104: 3020-22.

23. Vermeesch P, Nong Z, Gillinjs H. et al. Prolonged L- Arginine administration but not inducible nitric oxide synthase gene transfer reduces neointima formation after stent injury in rats. J Am Coll Cardiol 2001; 37(Suppl A): 1A-648A.

24. Sousa JE, Costa MA, Abizad AC et al. Lack of neointimal proliferation after implantation and three dimensional intravascular ultrasound study. Circulation 2001; 103: 192-95.

25. Morice MC, Serruys PW, Sousa JE et al. The RAVEL study: a randomized study with the sirolimus coated Bx Velocity Ballon-expandable stent in the treatment of patients with de novo native coronary lesions. Eur Heart J 2001; 22(Suppl 484).