Percutaneous transluminal coronary angioplasty in patients with two or more previous coronary artery bypass grafting operations
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G Dorros1, R F Lewin, L M Mathiak
1Department of Cardiology, St. Luke's Medical Center, Milwaukee, Wisconsin.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) successfully treated symptomatic myocardial ischemia in patients with multiple prior coronary artery bypass grafting (CABG) operations. While complications were low, lesion recurrence occurred in 35% of patients, necessitating further interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Patients with multiple prior coronary artery bypass grafting (CABG) operations often present with recurrent symptomatic myocardial ischemia.
- Percutaneous transluminal coronary angioplasty (PTCA) is an alternative revascularization strategy in this complex patient subset.
Purpose of the Study:
- To evaluate the safety and efficacy of PTCA in patients with at least two previous CABG operations and symptomatic myocardial ischemia.
Main Methods:
- Retrospective analysis of 76 patients undergoing PTCA between 1979 and 1986 after multiple CABG procedures.
- Detailed assessment of lesion characteristics, procedural success rates, complications, and clinical outcomes.
Main Results:
- Successful PTCA was achieved in 86% of patients, with high success rates in arterial lesions (88%) and vein grafts (83%).
- Significant complications occurred in 5% of patients, including one death related to vein graft embolization.
- At discharge, 65% of patients showed clinical improvement, but 35% experienced symptom recurrence, with 12 of 14 undergoing repeat successful PTCA.
Conclusions:
- PTCA is a feasible and effective treatment for symptomatic myocardial ischemia in patients with complex prior CABG.
- Careful patient selection and procedural technique are crucial, particularly for vein graft interventions.
- Long-term management requires addressing lesion recurrence and considering repeat revascularization strategies.
Abstract:
Between 1979 and 1986, 65 of 76 patients (86%) (82% men, with a mean age of 58 +/- 8 years) with greater than or equal to 2 previous coronary artery bypass grafting (CABG) operations and symptomatic myocardial ischemia underwent successful percutaneous transluminal coronary angioplasty (PTCA). Sixty-two patients had 2 prior CABG operations, 10 had 3 and 4 had 4. Clinical characteristics included prior myocardial infarctions in 49 (65%), severe angina (class III or IV) in 47 (62%) and left ventricular ejection fraction less than or equal to 35% in 13 (17%). There were 139 lesions dilated: 1 lesion in 39 (51%), 2 in 22 (29%) and greater than or equal to 3 in 15 (20%) patients. Arterial lesions were successfully dilated in 71 of 81 cases (88%), vein grafts in 44 of 53 (83%) and mammary artery grafts in 3 of 5 (60%). In 12 patients, PTCA was used to dilate significant lesions less than 15 days after CABG in vessels which were unable to be bypassed. Significant complications were encountered in 4 patients (5%). These included 3 of 53 vein graft dilatations with embolization (6%), with 1 resulting in infarction and death, and 1 patient dying after emergency CABG. At hospital discharge, 65 patients were clinically improved. An apparent symptom-related lesion recurrence occurred in 23 of 65 patients (35%), with 5 patients dying of cardiac causes, 4 having CABG without previous angiography and 12 of 14 patients undergoing repeat successful PTCA (mean time and standard deviation 9 +/- 6 months).(ABSTRACT TRUNCATED AT 250 WORDS)