Development of De Novo Chronic Total Occlusion in Native Coronary Arteries of Coronary Artery Bypass Grafting Surgery Patients

Year 2020, , 230 - 235, 29.10.2020

Ali Çoner , Sinan Akıncı , Ertan Akbay Ali Baran Budak Tonguç Saba Haldun Müderrisoğlu

https://doi.org/10.30565/medalanya.731636

Cited By: 1

Abstract

Aim: Postoperative de novo chronic total occlusions (CTOs) of preoperatively non-occluded native coronary arteries are commonly seen in coronary artery bypass grafting (CABG) surgery patients in the clinical follow-up; however, data about this course is limited. The aim of this study was to investigate the prevalence of new CTO development in native coronary arteries postoperatively and the clinical factors which may play role in this context.

Methods: A total of 492 CABG patients has been searched from the computer database at Başkent University Hospital Alanya Application and Research Center and patients with a recurrent coronary angiography (CAG) procedure after the first 6 months following surgery were involved in the study population. Recurrent CAG recordings were evaluated for the presence of new CTO development. Logistic regression analysis was used to search the role of demographical and angiographical characteristics in the development of de novo CTOs in native coronary arteries.

Results: Seventy-three CABG patients with recurrent CAG were involved in statistical analysis (Mean age was 65.2 ± 9.8 years; male gender 76.7%). Two hundred eighteen preoperatively non-occluded native coronary arteries were evaluated and 119 new CTOs were detected (54.5% of involved vessels). Preoperative proximal stenosis ≥90% is related to more than 3 times new CTO development (67.8% vs. 22.2%) (p<0.001). Dual antiplatelet therapy (DAPT) is found as a protective factor for the patency of native coronary arteries (HR:-0.259; 95% CI:-0.475 to -0.017; p=0.036).

Conclusion: De novo CTO development in native coronary arteries is commonly seen in CABG patients postoperatively. Significance of preoperative stenosis and absence of DAPT seem to be the essential factors in new CTO occurrence.

Keywords

coronary artery bypass grafting, native coronary arteries, chronic total occlusions

Supporting Institution

Başkent University

Project Number

KA19-442

Thanks

Authors thank to Dr. Taylan Erdem Şahin for his invaluable contributions.

Koroner Arter Bypass Greft Cerrahisi Hastalarının Nativ Koroner Arterlerinde Yeni Kronik Total Oklüzyon Gelişimi

Abstract

Amaç: Koroner arter bypass greftleme (KABG) cerrahisi hastalarının postoperatif klinik takibinde preoperatif olarak tam tıkalı olmayan nativ koroner arterlerin kronik total oklüde (KTO) hale gelmesi sık görülse de, seyriyle ilgili veriler kısıtlıdır. Çalışmamızın amacı postoperatif dönemde nativ koroner arterlerde yeni KTO gelişim sıklığını ve bu konuda rol oynayan faktörleri araştırmaktır.

Yöntem: Başkent Üniversitesi Hastanesi Alanya Uygulama ve Araştırma Merkezi’nde gerçekleştirilen tüm KABG operasyonları bilgisayar sisteminden tarandı ve postoperatif ilk 6 aylık dönemden sonra rekürren koroner anjiyografi (KAG) prosedürü uygulanan hastalar çalışma grubuna alındı. Rekürren KAG görüntüleri yeni KTO gelişimi açısından değerlendirildi ve nativ koroner arterlerde yeni KTO gelişimine yol açan demografik ve anjiyografik özellikler lojistik regresyon analizi kullanılarak test edildi.

Bulgular: Rekürren KAG yapılmış olan 73 KABG hastası istatistiksel analize dahil edildi (Ortalama yaş 65.2 ± 9.8 yıl; erkek cinsiyet %76.7). Preoperatif olarak tam tıkalı olmayan ve greftlenmiş olan 218 nativ koroner arter incelendi ve 119’unda (%54.5) yeni KTO saptandı. Preoperatif proksimal darlığın ≥%90 olması 3 kat daha fazla yeni KTO gelişimi ile ilişkili bulundu (%67.8 vs. %22.2) (p<0.001). İkili antiplatelet tedavisinin nativ koroner arterlerin açıklığını koruyucu rolü olduğu tespit edildi (HR:-0.259; %95 CI:-0.475’den -0.017’ye; p=0.036).

Sonuç: Nativ koroner arterlerde postoperatif yeni KTO gelişimi CABG hastalarında sık görülmektedir. Preoperatif darlığın daha ciddi olması ve ikili antiplatelet tedavinin yokluğu yeni KTO gelişimi için temel faktörler olarak bulundu.

Keywords

koroner arter bypass greftleme, nativ koroner arterler, kronik total oklüzyon

Project Number

KA19-442

References

• 1. Rocha EAV. Fifty years of coronary artery bypass surgery. Braz J Cardiovsc Surg. 2017; 32(4):II-III. PMID: 28977193.
• 2. Janiec M, Nazari Shafti TZ, Dimberg A, Lagerqvist B, Lindblom RPF. Graft failure and recurrence of symptoms after coronary artery bypass grafting. Scand Cardiovasc J. 2018;52(3):113-19. PMID: 29508655.
• 3. Borges JC, Lopes N, Soares PR, Góis AF, Stolf NA, Oliveira SA, et al. Five-year follow-up angiographic disease progression after medicine, angioplasty, or surgery. J Cardiothorac Surg. 2010;5:91. PMID: 20977758.
• 4. Tanaka A, Ishii H, Oshima H, Shibata Y, Tatami Y, Osugi N, et al. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting. Heart Vessels. 2016;31(7):1056-60. PMID: 26174429.
• 5. Budassi S, Zivelonghi C, Dens J, Bagnall AJ, Knaapen P, Avran A, et al. Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion-percutaneous coronary intervention: procedural and clinical outcomes from the registry of crossboss and hybrid procedures in France, the Netherlands, Belgium, and Unites Kingdom (RECHARGE). Catheter Cardiovasc Interv. 2020;May 5. Online ahead of print. PMID: 32369681 doi: 10.1002/ccd.28954.
• 6. Teramoto T, Tsuchikane E, Matsuo H, Suzuki Y, Ito T, Ito T, et al. Initial success rate of percutaneous coronary intervention for chronic total occlusion in a native coronary artery is decreased in patients who underwent previous coronary artery bypass graft surgery. JACC Cardiovasc Interv. 2014;7(1):39-46. PMID: 24456717.
• 7. Bartnes K, Hermansen SE, Dahl-Eriksen Ø, Bahar R, Busund R, Sørlie DG, et al. Arterial grafts do not counteract target vessel occlusion. Eur J Cardiothorac Surg. 2013;44(5):e320-4. PMID: 23956270.
• 8. Pereg D, Fefer P, Samuel M, Wolff R, Czarnecki A, Deb S, et al. Native coronary artery patency after coronary artery bypass surgery. JACC Cardiovasc Interv. 2014;7(7):761-7. PMID: 25060019.
• 9. Glineur D, Hanet C. Competitive flow in coronary bypass surgery: is it a problem? Curr Opin Cardiol. 2012;27(6):620-8. PMID: 23075821.
• 10. Tinica G, Chistol RO, Enache M, Leon Constantin MM, Ciocoiu M, Furnica C. Long-term graft patency after coronary artery bypass grafting: effects of morphological and pathophysiological factors. Anatol J Cardiol. 2018;20(5):275-82. PMID: 30391966.
• 11. Sabik JF 3rd, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM. Does competitive flow reduce internal thoracic artery graft patency? Ann Thorac Surg. 2003;76(5):1490-6. PMID: 14602274.
• 12. Dogan P, Kuyumcu MS, Demiryapan E, Arisoy F, Ozeke O. Competitive coronary flow between the native left anterior descending artery and left internal mammary artery graft: is it a surrogate angiographic marker of over-or-unnecessary revascularization decision in daily practice? Int J Angiol. 2017;26(1):27-31. PMID: 28255212.
• 13. Lopes RD, Mehta RH, Hafley GE, Williams JB, Mack MJ, Peterson ED, et al; Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) Investigators. Relationship between vein graft failure and subsequent clinical outcomes after coronary artery bypass surgery. Circulation. 2012;125(6):749-56. PMID: 22238227.
• 14. Cataldo G, Braga M, Pirotta N, Lavezzari M, Rovelli F, Marubini E. Factors influencing 1-year patency of coronary artery saphenous vein grafts. Studio Indobufenenel Bypass Aortocoronarico (SINBA). Circulation. 1993;88(5 Pt 2):II93-8. PMID: 8222202.
• 15. Zhao Q, Zhu Y, Xu Z, Cheng Z, Mei J, Chen X, et al. Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: a randomized clinical trial. JAMA. 2018;319(16):1677-86. PMID: 29710164.
• 16. Cardoso R, Knijnik L, Whelton SP, Rivera M, Gluckman TJ, Metkus TS, et al. Dual versus single antiplatelet therapy after coronary artery bypass graft surgery: an updated meta-analysis. Int J Cardiol. 2018;269:80-8. PMID: 30072154.
• 17. Iqbal J, Zhang YJ, Holmes DR, Morice MC, Mack MJ, Kappetein AP, et al. Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting: insights from the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up. Circulation. 2015;131(14):1269-77. PMID: 25847979.
• 18. Makuuchi H, Furuse A, Endo M, Nakamura H, Daida H, Watanabe M, et al. Effect of pravastatin on progression of coronary atherosclerosis in patients after coronary artery bypass surgery. Circ J. 2005;69(6):636-43. PMID: 15914938.
• 19. Kulik A, Ruel M. Statins and coronary artery bypass graft surgery: preoperative and postoperative efficacy and safety. Expert Opin Drug Saf. 2009;8(5):559-71. PMID: 19673591.