| Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery. | |
| | |
MedLine Citation:
|
PMID: 8890807 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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 dealth 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 < 40%, unstable angina, number of diseased vessels and diabetes mellitus as independent correlates of mortality for the entire group. CONCLUSIONS: In this nonrandomized series of patients with previous CABG requiring revascularization, an initial stategy of either PTCA or re-CABG resulted in equivalent overall survival, event-free survival and relief of angina. PTCA offers lower procedural morbidity and mortality risks, although it is associated with less complete revascularization and a greater need for subsequent revascularization procedures. |
| | |
Authors:
|
W J Stephan; J H O'Keefe; J M Piehler; B D McCallister; R S Dahiya; T M Shimshak; R W Ligon; G O Hartzler |
Related Documents
:
|
7942547 - Predicting hospital costs for first-time coronary artery bypass grafting from preoperat... 19853087 - A three-group model to predict mortality in emergent coronary artery bypass graft surgery. 16905627 - Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyo... 2296887 - Changing use of coronary angioplasty and coronary bypass surgery in the treatment of ch... 18925607 - Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. 6710577 - A clinical and electrocardiographic method of assessing the severity of aortic stenosis. |
Publication Detail:
|
Type: Comparative Study; Journal Article |
Journal Detail:
|
Title: Journal of the American College of Cardiology Volume: 28 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1996 Nov |
Date Detail:
|
Created Date: 1996-12-09 Completed Date: 1996-12-09 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1140-6 Citation Subset: AIM; IM |
Affiliation:
|
Mid American Heart Institute, Saint Luke's Hospital, Kansas City, Missouri, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Angina Pectoris / physiopathology, therapy Angioplasty, Transluminal, Percutaneous Coronary* Coronary Artery Bypass* Evaluation Studies as Topic Female Follow-Up Studies Hospital Mortality Humans Longitudinal Studies Male Postoperative Complications Reoperation Retrospective Studies Survival Analysis Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Chronic arterial responses to stent implantation: a serial intravascular ultrasound analysis of Palm...
Next Document: A model that predicts morbidity and mortality after coronary artery bypass graft surgery.