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Nonrevascularizable coronary artery disease following coronary artery bypass graft surgery: a population-based study
Thomas J Kiernan1, Barry A Boilson, Gurpreet S Sandhu
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Recurrent angina after coronary artery bypass grafting (CABG) affects 17.9-33.2 per 100,000 population yearly. Further revascularization did not improve survival, with renal dysfunction, diabetes, and LV dysfunction predicting mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Therapeutic options for recurrent cardiac ischemia post-coronary artery bypass grafting (CABG) can be limited.
- Some patients with recurrent angina after CABG may be considered nonrevascularizable.
Purpose of the Study:
- To understand the incidence and outcomes of patients with recurrent angina after CABG.
- To evaluate the impact of further revascularization on mortality and morbidity in this cohort.
Main Methods:
- Population-based study of post-CABG patients with angina undergoing coronary angiography (2001-2005).
- Analysis of medical records and angiographic findings.
- Comparison of outcomes between patients receiving further revascularization (PCI or redo CABG) and those managed medically.
Main Results:
- Identified a yearly incidence of 17.9-33.2 patients with nonrevascularizable angina per 100,000 population.
- Further revascularization (PCI or redo CABG) was not associated with improved all-cause or cardiac mortality.
- Renal dysfunction, diabetes, and severe left ventricular dysfunction were predictors of mortality, not the lack of revascularization.
Conclusions:
- Further revascularization in patients with recurrent angina post-CABG did not improve mortality or morbidity.
- Future therapeutic development for this population should consider the identified incidence and outcomes.
- Understanding predictors of mortality is crucial for managing nonrevascularizable angina post-CABG.
Aims:
Therapeutic options for patients with recurrent cardiac ischemia after coronary artery bypass surgery may be limited and some patients may be considered nonrevascularizable. To further the understanding of this patient cohort, we performed a population-based study of post-coronary bypass patients who developed recurrent angina.
Methods And Results:
Patients who underwent coronary artery and bypass graft angiography at Mayo Clinic from 2001 to 2005 were identified. Medical records were reviewed to determine indication for angiography, and angiographic analysis was performed in all patients. Among 133 000 residents of Olmsted County, Minnesota, 347 post-bypass patients with angina underwent coronary angiography from 2001 to 2005. Of these, 177 patients received further revascularization (145 percutaneous coronary intervention and 32 redo coronary artery bypass grafting) and the remaining 170 patients were managed medically. Revascularization was not associated with improvement in all-cause or cardiac mortality. Multivariate analysis identified renal dysfunction, diabetes, and severe left ventricular dysfunction but not the lack of revascularization as predictors of mortality.
Conclusion:
In this population-based study, we identified a yearly incidence range of 17.9-33.2 patients with nonrevascularizable angina after coronary artery bypass grafting per 100 000 population. Further revascularization was not associated with improved mortality or morbidity. Attempts to develop therapeutics for this population must consider the incidence and outcomes of this cohort.
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