Anticipated impact of drug-eluting stents on referral patterns for coronary artery bypass graft surgery: A population-based angiographic analysis

Brian D. Powell, Charanjit Rihal, Malcolm R. Bell, Kenton J. Zehr, David Holmes

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Objectives: To determine the clinical and angiographic characteristics of patients who underwent coronary artery bypass graft (CABG) surgery before the availability of drug-eluting stents (DES) and to project the potential impact of percutaneous coronary intervention using DES. Patients and Methods: We reviewed the coronary angiograms obtained between March 1999 and December 2001 of 192 consecutive patients from Olmsted County, Minnesota, who had undergone isolated CABG surgery for the first time. Three interventional cardiologists categorized the patients into 1 of 4 groups on the basis of technical feasibility of complete revascularization by percutaneous coronary intervention with DES. Results: The study population consisted primarily of men (78%), with a mean age of 67 years. Of the 192 patients, 58 (30%) had diabetes mellitus, and 124 (65%) had 3-vessel disease. Twelve patients (6%) had lesions suitable for stents that matched the inclusion criteria for DES in recently published trials; 77 (40%) had lesions suitable for stents but had lesion characteristics not included in the initial DES trials. Thirty-two patients (17%) had target lesions considered technically difficult, but feasible, for stent placement. Seventy-one patients (37%) had lesions unsuitable for percutaneous coronary intervention (75% of these due to chronic occlusions) with the current stent delivery technology. Conclusion: This population-based analysis suggests that only a small proportion of patients undergoing CABG surgery meets the strict angiographic eligibility criteria for DES on the basis of recent trials. However, up to 46% of current CABG patients may ultimately undergo conversion to DES. The remaining 54% of this patient population may still not be ideal candidates for DES with the current stent delivery technology.

Original languageEnglish (US)
Pages (from-to)769-772
Number of pages4
JournalMayo Clinic Proceedings
Volume79
Issue number6
StatePublished - 2004

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Drug-Eluting Stents
Coronary Artery Bypass
Referral and Consultation
Transplants
Population
Stents
Percutaneous Coronary Intervention
Technology
Diabetes Mellitus
Angiography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Anticipated impact of drug-eluting stents on referral patterns for coronary artery bypass graft surgery : A population-based angiographic analysis. / Powell, Brian D.; Rihal, Charanjit; Bell, Malcolm R.; Zehr, Kenton J.; Holmes, David.

In: Mayo Clinic Proceedings, Vol. 79, No. 6, 2004, p. 769-772.

Research output: Contribution to journalReview article

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abstract = "Objectives: To determine the clinical and angiographic characteristics of patients who underwent coronary artery bypass graft (CABG) surgery before the availability of drug-eluting stents (DES) and to project the potential impact of percutaneous coronary intervention using DES. Patients and Methods: We reviewed the coronary angiograms obtained between March 1999 and December 2001 of 192 consecutive patients from Olmsted County, Minnesota, who had undergone isolated CABG surgery for the first time. Three interventional cardiologists categorized the patients into 1 of 4 groups on the basis of technical feasibility of complete revascularization by percutaneous coronary intervention with DES. Results: The study population consisted primarily of men (78{\%}), with a mean age of 67 years. Of the 192 patients, 58 (30{\%}) had diabetes mellitus, and 124 (65{\%}) had 3-vessel disease. Twelve patients (6{\%}) had lesions suitable for stents that matched the inclusion criteria for DES in recently published trials; 77 (40{\%}) had lesions suitable for stents but had lesion characteristics not included in the initial DES trials. Thirty-two patients (17{\%}) had target lesions considered technically difficult, but feasible, for stent placement. Seventy-one patients (37{\%}) had lesions unsuitable for percutaneous coronary intervention (75{\%} of these due to chronic occlusions) with the current stent delivery technology. Conclusion: This population-based analysis suggests that only a small proportion of patients undergoing CABG surgery meets the strict angiographic eligibility criteria for DES on the basis of recent trials. However, up to 46{\%} of current CABG patients may ultimately undergo conversion to DES. The remaining 54{\%} of this patient population may still not be ideal candidates for DES with the current stent delivery technology.",
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N2 - Objectives: To determine the clinical and angiographic characteristics of patients who underwent coronary artery bypass graft (CABG) surgery before the availability of drug-eluting stents (DES) and to project the potential impact of percutaneous coronary intervention using DES. Patients and Methods: We reviewed the coronary angiograms obtained between March 1999 and December 2001 of 192 consecutive patients from Olmsted County, Minnesota, who had undergone isolated CABG surgery for the first time. Three interventional cardiologists categorized the patients into 1 of 4 groups on the basis of technical feasibility of complete revascularization by percutaneous coronary intervention with DES. Results: The study population consisted primarily of men (78%), with a mean age of 67 years. Of the 192 patients, 58 (30%) had diabetes mellitus, and 124 (65%) had 3-vessel disease. Twelve patients (6%) had lesions suitable for stents that matched the inclusion criteria for DES in recently published trials; 77 (40%) had lesions suitable for stents but had lesion characteristics not included in the initial DES trials. Thirty-two patients (17%) had target lesions considered technically difficult, but feasible, for stent placement. Seventy-one patients (37%) had lesions unsuitable for percutaneous coronary intervention (75% of these due to chronic occlusions) with the current stent delivery technology. Conclusion: This population-based analysis suggests that only a small proportion of patients undergoing CABG surgery meets the strict angiographic eligibility criteria for DES on the basis of recent trials. However, up to 46% of current CABG patients may ultimately undergo conversion to DES. The remaining 54% of this patient population may still not be ideal candidates for DES with the current stent delivery technology.

AB - Objectives: To determine the clinical and angiographic characteristics of patients who underwent coronary artery bypass graft (CABG) surgery before the availability of drug-eluting stents (DES) and to project the potential impact of percutaneous coronary intervention using DES. Patients and Methods: We reviewed the coronary angiograms obtained between March 1999 and December 2001 of 192 consecutive patients from Olmsted County, Minnesota, who had undergone isolated CABG surgery for the first time. Three interventional cardiologists categorized the patients into 1 of 4 groups on the basis of technical feasibility of complete revascularization by percutaneous coronary intervention with DES. Results: The study population consisted primarily of men (78%), with a mean age of 67 years. Of the 192 patients, 58 (30%) had diabetes mellitus, and 124 (65%) had 3-vessel disease. Twelve patients (6%) had lesions suitable for stents that matched the inclusion criteria for DES in recently published trials; 77 (40%) had lesions suitable for stents but had lesion characteristics not included in the initial DES trials. Thirty-two patients (17%) had target lesions considered technically difficult, but feasible, for stent placement. Seventy-one patients (37%) had lesions unsuitable for percutaneous coronary intervention (75% of these due to chronic occlusions) with the current stent delivery technology. Conclusion: This population-based analysis suggests that only a small proportion of patients undergoing CABG surgery meets the strict angiographic eligibility criteria for DES on the basis of recent trials. However, up to 46% of current CABG patients may ultimately undergo conversion to DES. The remaining 54% of this patient population may still not be ideal candidates for DES with the current stent delivery technology.

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