Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure

S. S. Virani, M. Alam, C. E. Mendoza, H. Arora, A. C. Ferreira, Eduardo De Marchena

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3 Citations (Scopus)

Abstract

Background. Despite technical advances in coronary artery bypass grafting (CABG), early postoperative myocardial ischaemia still remains a challenging problem. The aim of this study was to determine the incidence, clinical features, angiographic characteristics, and management of early graft failure in the present CABG era. Methods. Between January 1997 and December 2002, 1731 patients underwent CABG at our institution. Coronary angiography was performed in patients with clinical evidence of early postoperative ischaemia (≤3 months). Thirty of these patients with graft failure constituted the population of this study. Results. Off-pump and on-pump CABG were almost evenly performed in these patients [n=16 (53%) and n=14 (47%) respectively]. Acute myocardial infarction and unstable angina were the leading indications for coronary angiography in the majority of patients [n=28 (93%)]. The most common cause of graft failure was occlusion / thrombosis [n=20 (67%)]. Percutaneous coronary intervention (PCI) was offered to the majority of patients [n=22 (73%)]. Of these patients, 14 underwent PCI to native coronary arteries, whereas eight underwent PCI to the culprit vessel. Three patients underwent reoperation, and five received medical management. Four patients (13%) died in hospital (two after redo CABG, one after unsuccessful PCI, and one patient managed medically). Two patients (7%) had nonfatal major complications (one non-ST-elevation myocardial infarction and one stroke). Conclusion. Early graft failure generally presents as acute coronary syndrome. Graft occlusion/thrombosis is the leading cause of ischaemia. Patients with graft failure can undergo PCI with a relatively low risk, but the need for redo CABG in associated with a high mortality.

Original languageEnglish
Pages (from-to)13-17
Number of pages5
JournalNetherlands Heart Journal
Volume17
Issue number1
StatePublished - Jan 1 2009

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Coronary Vessels
Transplants
Coronary Artery Bypass
Percutaneous Coronary Intervention
Coronary Angiography
Thrombosis
Ischemia
Unstable Angina
Acute Coronary Syndrome
Reoperation
Myocardial Ischemia
Stroke
Myocardial Infarction
Mortality
Incidence

Keywords

  • Coronary angiography
  • Coronary graft failure
  • Post-CABG

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure. / Virani, S. S.; Alam, M.; Mendoza, C. E.; Arora, H.; Ferreira, A. C.; De Marchena, Eduardo.

In: Netherlands Heart Journal, Vol. 17, No. 1, 01.01.2009, p. 13-17.

Research output: Contribution to journalArticle

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abstract = "Background. Despite technical advances in coronary artery bypass grafting (CABG), early postoperative myocardial ischaemia still remains a challenging problem. The aim of this study was to determine the incidence, clinical features, angiographic characteristics, and management of early graft failure in the present CABG era. Methods. Between January 1997 and December 2002, 1731 patients underwent CABG at our institution. Coronary angiography was performed in patients with clinical evidence of early postoperative ischaemia (≤3 months). Thirty of these patients with graft failure constituted the population of this study. Results. Off-pump and on-pump CABG were almost evenly performed in these patients [n=16 (53{\%}) and n=14 (47{\%}) respectively]. Acute myocardial infarction and unstable angina were the leading indications for coronary angiography in the majority of patients [n=28 (93{\%})]. The most common cause of graft failure was occlusion / thrombosis [n=20 (67{\%})]. Percutaneous coronary intervention (PCI) was offered to the majority of patients [n=22 (73{\%})]. Of these patients, 14 underwent PCI to native coronary arteries, whereas eight underwent PCI to the culprit vessel. Three patients underwent reoperation, and five received medical management. Four patients (13{\%}) died in hospital (two after redo CABG, one after unsuccessful PCI, and one patient managed medically). Two patients (7{\%}) had nonfatal major complications (one non-ST-elevation myocardial infarction and one stroke). Conclusion. Early graft failure generally presents as acute coronary syndrome. Graft occlusion/thrombosis is the leading cause of ischaemia. Patients with graft failure can undergo PCI with a relatively low risk, but the need for redo CABG in associated with a high mortality.",
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