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[Angioplasty in patients already treated with aortocoronary bypass: immediate and short-term results]
A Marzocchi1, G Piovaccari, C Marrozzini
1Istituto di Malattie dell'Apparato Cardiovascolare, Università degli Studi, Bologna.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) in patients with prior bypass grafting shows good immediate results but high restenosis rates. Intracoronary stents may reduce restenosis, particularly in graft bodies.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Context:
- Percutaneous transluminal coronary angioplasty (PTCA) is a procedure for patients with prior aortocoronary bypass grafting (CABG).
- While PTCA yields good results in native vessels and graft anastomoses, restenosis remains a challenge, especially in graft bodies.
- Intracoronary stents are increasingly used, potentially improving outcomes and reducing restenosis incidence.
Purpose:
- To evaluate the number of PTCA procedures performed in CABG patients and their short-term outcomes.
- To assess the efficacy of PTCA and stent implantation in managing coronary artery disease in patients with prior CABG.
Summary:
- A 1993 study across 10 Italian centers reported 3,519 PTCA procedures, with 233 (6.6%) in CABG patients.
- Angiographic and clinical success was achieved in 92% of cases, with major complications in 4.7% including myocardial infarctions and deaths.
- Stent implantation occurred in 19.3% of cases. Six-month follow-up showed 63.6% asymptomatic patients, but 32.9% experienced angina, necessitating further interventions.
Impact:
- The study highlights the effectiveness of PTCA in CABG patients, with a significant success rate and manageable complication profile.
- The data suggests that while PTCA offers immediate benefits, restenosis remains a concern, underscoring the role of intracoronary stents.
- Long-term follow-up data from Bologna indicates sustained outcomes, providing valuable insights for managing complex coronary artery disease.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) is performed in patients with prior aortocoronary bypass grafting (CABG) with good results in native vessels and in the coronary graft anastomoses, but with high percentage of restenosis in the body and in the proximal portion of the grafts. The use of intracoronary stents is now spreading, their implantation can improve the immediate outcome and may decrease the incidence of restenosis, mostly in the body of the graft. In order to evaluate PTCA in CABG patients as to numbers and short-term results, the data regarding the year 1993 of 10 Italian Centers are presented. In these Centers 3,519 PTCA were performed, 233 (6.6%) of which on CABG patients. PTCA has been performed in native vessels in 136 patients and in CABG in 126 patients, with 29 patients treated in native vessels as well as in CABG. An angiographic and clinical success was obtained in 215 patients (92%). A major complication occurred in 11 (4.7%) patients with 8 (3.4%) myocardial infarctions, and 3 (1.3%) deaths. Forty-five (19.3%) stents were implanted with considerable differences among the Centers. One hundred seventy-three patients were followed up for 6 months: 110 (63.6%) were asymptomatic and 57 (32.9%) had complained angina; 27 (15.6%) had a second PTCA and 6 (3.5%) had CABG surgery; 1 patient (0.6%) suffered a myocardial infarction and 7 (4%) died (3 due to CABG reinterventions). To evaluate the long-term follow-up, data regarding 58 patients submitted to PTCA in the Institute of Cardiology of Bologna since 1985 to 1993 are showed, with a 3-year follow-up (36 +/- 26 months).(ABSTRACT TRUNCATED AT 250 WORDS)