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

• Published in: Canadian journal of cardiology 2016-11, Vol.32 (11), p.1326-1331
• Main Authors: Pereg, David, Fefer, Paul, Samuel, Michelle, Shuvy, Mony, Deb, Saswata, Sparkes, John D., Fremes, Stephan E., Strauss, Bradley H.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Coronary Angiography; Coronary Artery Bypass; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - epidemiology; Coronary Occlusion - surgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - epidemiology; Percutaneous Coronary Intervention - statistics & numerical data; Postoperative Complications - epidemiology; Recurrence
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2016.01.015

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