Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery
| Autor: | Ben D. McCallister, Jeffrey M. Piehler, Robert W. Ligon, William J. Stephan, Geoffrey O. Hartzler, James H. O'Keefe, Rajiv S. Dahiya, Thomas M. Shimshak |
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| Rok vydání: | 1996 |
| Předmět: |
Male
Reoperation medicine.medical_specialty medicine.medical_treatment Population Revascularization Angina Pectoris Coronary artery disease Angina Postoperative Complications Internal medicine Angioplasty medicine Humans Hospital Mortality Longitudinal Studies cardiovascular diseases Derivation Angioplasty Balloon Coronary Coronary Artery Bypass education Aged Retrospective Studies education.field_of_study Ejection fraction business.industry medicine.disease Survival Analysis Surgery Treatment Outcome surgical procedures operative Bypass surgery Evaluation Studies as Topic Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 28:1140-1146 |
| ISSN: | 0735-1097 |
| Popis: | Objectives.We attempted to determine the relative risks and benefits of percutaneous transluminal coronary angioplasty (PTCA) and repeat coronary artery bypass grafting (re-CABG) in patients with previous coronary bypass surgery (CABG).Background.Due to an expanding population of patients with surgically treated coronary artery disease and the natural progression of atherosclerosis, an increasing number of patients with previous CABG require repeat revascularization procedures. Although there are randomized comparative data for CABG versus medical therapy and, more recently, versus PTCA, these studies have excluded patients with previous CABG.Methods.We retrospectively analyzed data from 632 patients with previous CABG who required either elective re-CABG (n = 164) or PTCA (n = 468) at a single center during 1987 through 1988. The PTCA and re-CABG groups were similar with respect to gender (83% vs. 85% male), age >70 years (21% vs. 23%), mean left ventricular ejection fraction (46% vs. 48%), presence of class III or IV angina (70% vs. 63%) and three-vessel coronary artery disease (77% vs. 74%).Results.Complete revascularization was achieved in 38% of patients with PTCA and 92% of those with re-CABG (p < 0.0001). The in-hospital complication rates were significantly lower in the PTCA group: death (0.3% vs. 7.3%, p < 0.0001) and Q wave myocardial infarction (MI) (0.9% vs. 6.1%, p < 0.0001). Actuarial survival was equivalent at 1 year (PTCA 95% vs. re-CABG 91%) and 6 years (PTCA 74% vs. re-CABG 73%) of follow-up (p = 0.32). Both procedures resulted in equivalent event-free survival (freedom from death or Q wave MI) and relief of angina; however, the need for repeat percutaneous or surgical revascularization, or both, by 6 years was significantly higher in the PTCA group (PTCA 64% vs. re-CABG 8%, p < 0.0001). Multivariate analysis identified age >70 years, left ventricular ejection fraction |
| Databáze: | OpenAIRE |
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