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[Angioplasty in native coronary circulation in patients treated with myocardial revascularization]
W A Pimentel Filho1, E Ascer, J R Büchler
1Real e Benemérita Sociedade Portuguesa de Beneficência e Hospital, Israelita Albert Eistein, São Paulo.
Insights
Coronary angioplasty in native vessels is safe and effective for patients with prior bypass surgery. This interventional procedure demonstrates high success rates and favorable long-term outcomes in managing coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Context:
- Patients with prior coronary artery bypass graft (CABG) surgery often develop recurrent or progressive coronary artery disease (CAD).
- Native coronary vessels can remain targets for intervention even after bypass surgery.
- Evaluating revascularization strategies in this complex patient subset is crucial for optimizing outcomes.
Purpose:
- To assess the clinical efficacy and safety of percutaneous coronary angioplasty (angioplasty) in the native coronary arteries of patients who have previously undergone coronary artery bypass surgery.
- To analyze outcomes based on the reason for re-intervention: incomplete revascularization, disease progression in ungrafted vessels, or disease progression in grafted vessels.
Summary:
- A study of 69 patients with prior CABG who underwent angioplasty in native coronary arteries showed a primary success rate of 94%.
- Outcomes were favorable across all patient groups (incomplete revascularization, ungrafted, and grafted vessels), with low complication rates (4%) and no emergency surgeries or deaths.
- Follow-up revealed a 25% restenosis rate, with 8 patients successfully redilated. Survival was 95%, with 75% free of coronary events at 13 months.
Impact:
- Coronary angioplasty is a safe and effective treatment option for managing coronary artery disease in native vessels among patients with a history of bypass surgery.
- This approach offers a viable alternative or adjunct to further surgical intervention.
- The findings support the continued use of angioplasty for selected patients with complex CAD post-CABG.
Purpose:
To evaluate the clinical results after angioplasty in the native coronary vessels in patients who had undergone previous coronary artery surgery.
Methods:
From June 1987 to July 1990, 69 patients with previous coronary artery surgery underwent coronary angioplasty in the native arteries. Age ranged from 31 to 82 (mean = 57.5) years, fifty eight were males. Angina was present in all patients. The patients were classified in three groups according to the following criteria: group I--incomplete revascularization following bypass surgery (28 patients); group II--progression of the disease in ungrafted vessels (24 patients) and group III--progression of the disease in grafted vessels (17 patients).
Results:
Primary success was achieved in 94% (65/69). Ninety-five percent in group I, 92% in group II and 94% in group III. Complications occurred in 4%; emergency surgery or deaths were not observed in this study. Forty patients (61%) repeated coronary arteriography an average follow-up of 4 months and restenosis was detected in 10 (25%); 8 of them were redilated. Survival rates was 95% and 75% of them were free of coronary events after an average follow-up of 13 months.
Conclusion:
Coronary angioplasty in these patients is a safe and effective interventional procedure in the treatment of coronary artery disease in native coronary vessels.