Impact of Postprocedural Graft Flow on Outcomes Following Chronic Total Occlusion Intervention in Postcoronary Artery Bypass Graft Patients: A Detailed Angiographic Analysis.

Autor: Poletti E; HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium., Dens J; Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium., Egred M; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom., Munafò AR; De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy., Castaldi G; Department of Cardiology, Universitair Ziekenhuis (UZ) Leuven, Leuven, Belgium., De Cock E; Department of Cardiology, AZ Sint-Jan Brugge, Brugge, Belgium., Jossart A; Department of Cardiology, Hôpital de Jolimont, La Louvrière, Belgium., Poels E; Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium., Khandaker AH; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom., Lesizza P; Department of Cardiology, Universitair Ziekenhuis (UZ) Leuven, Leuven, Belgium., Zivelonghi C; HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium., Scott B; HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium., Haine SEF; Department of Cardiology, Universitair Ziekenhuis Antwerpen (UZA), Antwerp, Belgium; University of Antwerp (UA), Antwerp, Belgium., Kayaert P; Department of Cardiology, Jessa Hospital, Hasselt, Belgium., Bataille Y; Department of Cardiology, Jessa Hospital, Hasselt, Belgium., Cornelis K; Department of Cardiology, AZ Maria Middelares Ghent, Ghent, Belgium., Saad G; Department of Cardiology, CHR de la Citadelle, Liège, Belgium., Coussement P; Department of Cardiology, AZ Sint-Jan Brugge, Brugge, Belgium., Bennett J; Department of Cardiology, Universitair Ziekenhuis (UZ) Leuven, Leuven, Belgium., Droogmans S; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Cardiology, Brussels, Belgium., Oreglia J; De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy., Ungureanu C; Department of Cardiology, Hôpital de Jolimont, La Louvrière, Belgium., Iqbal MB; Department of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada., Agostoni P; HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium. Electronic address: agostonipf@gmail.com.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Sep 01; Vol. 226, pp. 24-33. Date of Electronic Publication: 2024 Jun 15.
DOI: 10.1016/j.amjcard.2024.06.015
Abstrakt: Chronic total occlusions (CTOs) are frequent in patients with previous coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is the usual revascularization strategy. Whether or not the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes after CTO-PCI is unknown. We sought to evaluate the impact of post-PCI graft patency on the durability of CTO-PCI. In total, 259 patients with previous CABG who underwent CTO-PCI in 12 international centers in 2019 to 2023 were categorized into "grafted" and "ungrafted" groups based on the presence of graft on a CTO vessel. The grafted group was subdivided into "graft-occluded" and "graft-patent" groups, depending on graft patency. The primary end points were (1) technical success rate, (2) target vessel failure, and (3) CTO failure rates at 1 year. CTO failure was defined as target vessel revascularization and/or significant in-stent restenosis. A total of 199 patients (77%) were in the grafted group. Grafted CTOs showed higher complexity and lower technical success rates (70% vs 80%, p = 0.004) than nongrafted CTOs. Of the grafted CTOs, 140 (70%) were in the grafted-occluded group and 59 (30%) were in the grafted-patent group. The technical success was lower in the former group (65% vs 81%, p = 0.022). An occluded graft was an independent predictor of technical failure (odds ratio 2.04, 95% confidence interval 1.03 to 4.76, p = 0.049) and persistent post-PCI graft patency was a strong independent predictor of CTO failure at 1 year (hazard ratio 5.6, 95% confidence interval 1.2 to 27.5, log-rank p = 0.033). In conclusion, in patients with previous CABG who underwent CTO-PCI, post-PCI graft patency was a significant predictor of CTO failure.
Competing Interests: Declaration of competing interest The authors have no competing interests to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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