Influence of procedural success on immediate and long-term clinical outcome of patients undergoing percutaneous revascularization of occluded coronary artery bypass vein grafts

Peter B. Berger, Malcolm R. Bell, Diane E. Grill, Robert Simari, Guy Reeder, David Holmes

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives. This study sought to determine whether successful recanalization of an occluded vein graft is associated with improvement in long-term clinical outcome. Background. Coronary angioplasty of occluded vein grafts is associated with a lower initial success rate and a higher complication rate than angioplasty of vein grafts with subtotal stenoses and native coronary arteries. Whether successful angioplasty improves clinical outcome is unknown. Methods. We analyzed 77 consecutive patients who underwent angioplasty of an occluded saphenous vein coronary artery bypass graft between August 1983 and June 1994. Patients with a myocardial infarction in the previous 24 h were excluded from the study. Results. The mean age of the study cohort was 65 years; the mean (±SD) age of the treated grafts was 7.5 ± 3.9 years. As an adjunct to balloon angioplasty, stents were used in 9% of procedures, laser in 30%, and atherectomy in 16%, and thrombolytic therapy was administered in 23% of patients. The angioplasty success rate was 71%. Major complications within 30 days of the procedure included death in 5.2% of patients, Q wave myocardial infarction in 1.3% and repeat bypass surgery in 7.8%; these events occurred with similar frequency in patients in whom angiographic success was and was not achieved. Kaplan-Meier analysis comparing patients in whom angioplasty was successful (n = 55) and not successful (n = 22) revealed no differences in survival or occurrence of myocardial tion or recurrent severe angina between the two groups in the 3 years after the procedure. Univariate analysis identified the age of the graft and use of newer interventional devices as predictors of death or myocardial infarction during this time period; procedural success was not associated with freedom from these adverse events after adjusting for these variables. Conclusions. Angioplasty of occluded vein grafts is associated with a low initial success rate and a high complication rate. Successful angioplasty does not appear to reduce the occurrence of adverse events in the 3 years after the procedure.

Original languageEnglish (US)
Pages (from-to)1732-1737
Number of pages6
JournalJournal of the American College of Cardiology
Volume28
Issue number7
DOIs
StatePublished - Dec 1997

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Angioplasty
Coronary Artery Bypass
Veins
Transplants
Myocardial Infarction
Atherectomy
Balloon Angioplasty
Coronary Stenosis
Thrombolytic Therapy
Saphenous Vein
Kaplan-Meier Estimate
Reoperation
Stents
Lasers
Cohort Studies
Equipment and Supplies
Survival

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Influence of procedural success on immediate and long-term clinical outcome of patients undergoing percutaneous revascularization of occluded coronary artery bypass vein grafts. / Berger, Peter B.; Bell, Malcolm R.; Grill, Diane E.; Simari, Robert; Reeder, Guy; Holmes, David.

In: Journal of the American College of Cardiology, Vol. 28, No. 7, 12.1997, p. 1732-1737.

Research output: Contribution to journalArticle

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abstract = "Objectives. This study sought to determine whether successful recanalization of an occluded vein graft is associated with improvement in long-term clinical outcome. Background. Coronary angioplasty of occluded vein grafts is associated with a lower initial success rate and a higher complication rate than angioplasty of vein grafts with subtotal stenoses and native coronary arteries. Whether successful angioplasty improves clinical outcome is unknown. Methods. We analyzed 77 consecutive patients who underwent angioplasty of an occluded saphenous vein coronary artery bypass graft between August 1983 and June 1994. Patients with a myocardial infarction in the previous 24 h were excluded from the study. Results. The mean age of the study cohort was 65 years; the mean (±SD) age of the treated grafts was 7.5 ± 3.9 years. As an adjunct to balloon angioplasty, stents were used in 9{\%} of procedures, laser in 30{\%}, and atherectomy in 16{\%}, and thrombolytic therapy was administered in 23{\%} of patients. The angioplasty success rate was 71{\%}. Major complications within 30 days of the procedure included death in 5.2{\%} of patients, Q wave myocardial infarction in 1.3{\%} and repeat bypass surgery in 7.8{\%}; these events occurred with similar frequency in patients in whom angiographic success was and was not achieved. Kaplan-Meier analysis comparing patients in whom angioplasty was successful (n = 55) and not successful (n = 22) revealed no differences in survival or occurrence of myocardial tion or recurrent severe angina between the two groups in the 3 years after the procedure. Univariate analysis identified the age of the graft and use of newer interventional devices as predictors of death or myocardial infarction during this time period; procedural success was not associated with freedom from these adverse events after adjusting for these variables. Conclusions. Angioplasty of occluded vein grafts is associated with a low initial success rate and a high complication rate. Successful angioplasty does not appear to reduce the occurrence of adverse events in the 3 years after the procedure.",
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T1 - Influence of procedural success on immediate and long-term clinical outcome of patients undergoing percutaneous revascularization of occluded coronary artery bypass vein grafts

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AU - Simari, Robert

AU - Reeder, Guy

AU - Holmes, David

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N2 - Objectives. This study sought to determine whether successful recanalization of an occluded vein graft is associated with improvement in long-term clinical outcome. Background. Coronary angioplasty of occluded vein grafts is associated with a lower initial success rate and a higher complication rate than angioplasty of vein grafts with subtotal stenoses and native coronary arteries. Whether successful angioplasty improves clinical outcome is unknown. Methods. We analyzed 77 consecutive patients who underwent angioplasty of an occluded saphenous vein coronary artery bypass graft between August 1983 and June 1994. Patients with a myocardial infarction in the previous 24 h were excluded from the study. Results. The mean age of the study cohort was 65 years; the mean (±SD) age of the treated grafts was 7.5 ± 3.9 years. As an adjunct to balloon angioplasty, stents were used in 9% of procedures, laser in 30%, and atherectomy in 16%, and thrombolytic therapy was administered in 23% of patients. The angioplasty success rate was 71%. Major complications within 30 days of the procedure included death in 5.2% of patients, Q wave myocardial infarction in 1.3% and repeat bypass surgery in 7.8%; these events occurred with similar frequency in patients in whom angiographic success was and was not achieved. Kaplan-Meier analysis comparing patients in whom angioplasty was successful (n = 55) and not successful (n = 22) revealed no differences in survival or occurrence of myocardial tion or recurrent severe angina between the two groups in the 3 years after the procedure. Univariate analysis identified the age of the graft and use of newer interventional devices as predictors of death or myocardial infarction during this time period; procedural success was not associated with freedom from these adverse events after adjusting for these variables. Conclusions. Angioplasty of occluded vein grafts is associated with a low initial success rate and a high complication rate. Successful angioplasty does not appear to reduce the occurrence of adverse events in the 3 years after the procedure.

AB - Objectives. This study sought to determine whether successful recanalization of an occluded vein graft is associated with improvement in long-term clinical outcome. Background. Coronary angioplasty of occluded vein grafts is associated with a lower initial success rate and a higher complication rate than angioplasty of vein grafts with subtotal stenoses and native coronary arteries. Whether successful angioplasty improves clinical outcome is unknown. Methods. We analyzed 77 consecutive patients who underwent angioplasty of an occluded saphenous vein coronary artery bypass graft between August 1983 and June 1994. Patients with a myocardial infarction in the previous 24 h were excluded from the study. Results. The mean age of the study cohort was 65 years; the mean (±SD) age of the treated grafts was 7.5 ± 3.9 years. As an adjunct to balloon angioplasty, stents were used in 9% of procedures, laser in 30%, and atherectomy in 16%, and thrombolytic therapy was administered in 23% of patients. The angioplasty success rate was 71%. Major complications within 30 days of the procedure included death in 5.2% of patients, Q wave myocardial infarction in 1.3% and repeat bypass surgery in 7.8%; these events occurred with similar frequency in patients in whom angiographic success was and was not achieved. Kaplan-Meier analysis comparing patients in whom angioplasty was successful (n = 55) and not successful (n = 22) revealed no differences in survival or occurrence of myocardial tion or recurrent severe angina between the two groups in the 3 years after the procedure. Univariate analysis identified the age of the graft and use of newer interventional devices as predictors of death or myocardial infarction during this time period; procedural success was not associated with freedom from these adverse events after adjusting for these variables. Conclusions. Angioplasty of occluded vein grafts is associated with a low initial success rate and a high complication rate. Successful angioplasty does not appear to reduce the occurrence of adverse events in the 3 years after the procedure.

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