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In Vitro Model of Physiological and Pathological Blood Flow with Application to Investigations of Vascular Cell Remodeling
Published on: November 3, 2015
Six-year clinical and angiographic follow-up of patients with previously documented complete revascularization
E W Robert1, D F Guthaner, L Wexler
1Cardiology Division, Stanford University Medical Center, Stanford, California 94305, USA.
Insights
Late symptomatic deterioration after coronary bypass surgery is common. This often results from the progression of coronary artery disease, even with initially successful surgery and patent grafts.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Limited data exists on the long-term clinical and angiographic outcomes of patients following initially successful coronary artery bypass grafting (CABG).
- Assessing late graft patency and disease progression is crucial for understanding long-term patient status.
Purpose of the Study:
- To evaluate the late clinical and angiographic status of patients who underwent coronary bypass surgery with initially complete revascularization.
- To investigate the relationship between graft patency, progression of coronary artery disease, and long-term symptoms.
Main Methods:
- Follow-up angiography at 1 year and 6 years post-CABG in a cohort of 19 patients with complete revascularization.
- Assessment of graft patency, luminal narrowing in native vessels, and patient symptom status (angina).
Main Results:
- At 6 years, 86% of grafts remained patent.
- 52% of patients showed significant atherosclerotic progression (> or = 70% luminal narrowing) in major vessels.
- Late symptomatic deterioration (angina) was strongly associated with progression of coronary artery disease (88% of worsened patients) rather than graft failure.
Conclusions:
- Symptomatic deterioration is common in the late phase after coronary bypass surgery.
- Progression of underlying coronary artery disease, not graft failure, is the primary driver of late symptom recurrence.
- Long-term management strategies should address the progression of native coronary artery disease.
Abstract:
Relatively little information is available concerning the late clinical and angiographic status of patients with initially successful coronary bypass surgery. From 72 patients who had angiography 1 year after bypass surgery, we restudied at 6 years 19 patients with complete revascularization. At 1 year, 14 patients were asymptomatic and five had minimal anginal symptoms. Five years later, eight patients had redeveloped angina, and 11 retained their initial postoperative status. Overall graft patency at 6 years was 86%; 52% of the patients had atherosclerotic progression to > or = 70% luminal narrowing in a major unbypassed vessel or in a major vessel distal to bypass. The patients with unchanged symptoms all had patent grafts, while 11 of the 15 (73%) grafts were patent in patients with symptomatic deterioration (NS). However, progression of coronary disease occurred in seven of eight patients (88%) with worsened symptoms, as opposed to three of 11 patients with unchanged symptoms (P < 0.05). We conclude that late symptomatic deterioration following coronary bypass surgery is common, and that it usually reflects progression of coronary artery disease.
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