Optimal revascularization strategies for percutaneous coronary intervention of distal anastomotic lesions after coronary artery bypass surgery.

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Citation: Journal of Interventional Cardiology. 26(4):366-71, 2013 Aug.PMID: 23795684Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Coronary Artery Bypass/ae [Adverse Effects] | *Coronary Restenosis/th [Therapy] | *Graft Occlusion, Vascular/th [Therapy] | *Percutaneous Coronary Intervention | Aged | Aged, 80 and over | Angioplasty, Balloon, Coronary | Coronary Artery Bypass/mt [Methods] | Drug-Eluting Stents | Female | Humans | Male | Middle Aged | Reoperation | Retrospective Studies | Saphenous Vein/tr [Transplantation] | Stents | Treatment Outcome | Vascular PatencyYear: 2013ISSN:
  • 0896-4327
Name of journal: Journal of interventional cardiologyAbstract: BACKGROUND: Distal anastomotic lesions are the most common reason for venous graft failure especially early after bypass surgery. However, the best percutaneous method for treating these lesions is still controversial.CONCLUSIONS: When selecting the treatment modality for saphenous vein graft distal anastomotic lesions, BMS implantation should be discouraged while POBA and DES implantation can be performed with favorable long-term outcomes. The optimal treatment approach should be evaluated in large, randomized clinical trials. 2013, Wiley Periodicals, Inc.METHODS: All patients from 2/2000 to 1/2011 who underwent percutaneous coronary intervention of bypass graft distal anastomotic lesions were retrospectively enrolled. Among the 139 patients included, 26 (18.7%) were treated with plain old balloon angioplasty (POBA), 68 (48.9%) with bare metal stents (BMS), and 45 (32.4%) with drug-eluting stents (DES).OBJECTIVE: To determine the best revascularization strategy when treating distal anastomotic lesions.RESULTS: Baseline characteristics were generally comparable among the 3 groups. At 6 months' follow-up, the highest rate of target lesion revascularization-major adverse cardiac events (TLR-MACE) was seen in the BMS group compared to the DES and POBA groups (16.2 vs. 2.2 vs. 3.8%, respectively, P=0.03), which was driven mainly by the highest rates of death and TLR in the BMS group (11.8 and 4.7%, respectively). At 1-year follow-up, a higher rate of TLR-MACE was seen in the BMS group compared to the DES and POBA groups (20.6 vs. 11.1 vs. 7.7%, respectively, P=0.19). After adjustment, on Cox regression analysis for hazard ratios, no significant differences were found among the 3 groups at 1-year follow-up of TLR-MACE.All authors: Badr S, Barbash IM, Dvir D, Kitabata H, Loh JP, Pichard AD, Torguson R, Waksman RFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2014-08-21
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Journal Article MedStar Authors Catalog Article 23795684 Available 23795684

BACKGROUND: Distal anastomotic lesions are the most common reason for venous graft failure especially early after bypass surgery. However, the best percutaneous method for treating these lesions is still controversial.

CONCLUSIONS: When selecting the treatment modality for saphenous vein graft distal anastomotic lesions, BMS implantation should be discouraged while POBA and DES implantation can be performed with favorable long-term outcomes. The optimal treatment approach should be evaluated in large, randomized clinical trials. 2013, Wiley Periodicals, Inc.

METHODS: All patients from 2/2000 to 1/2011 who underwent percutaneous coronary intervention of bypass graft distal anastomotic lesions were retrospectively enrolled. Among the 139 patients included, 26 (18.7%) were treated with plain old balloon angioplasty (POBA), 68 (48.9%) with bare metal stents (BMS), and 45 (32.4%) with drug-eluting stents (DES).

OBJECTIVE: To determine the best revascularization strategy when treating distal anastomotic lesions.

RESULTS: Baseline characteristics were generally comparable among the 3 groups. At 6 months' follow-up, the highest rate of target lesion revascularization-major adverse cardiac events (TLR-MACE) was seen in the BMS group compared to the DES and POBA groups (16.2 vs. 2.2 vs. 3.8%, respectively, P=0.03), which was driven mainly by the highest rates of death and TLR in the BMS group (11.8 and 4.7%, respectively). At 1-year follow-up, a higher rate of TLR-MACE was seen in the BMS group compared to the DES and POBA groups (20.6 vs. 11.1 vs. 7.7%, respectively, P=0.19). After adjustment, on Cox regression analysis for hazard ratios, no significant differences were found among the 3 groups at 1-year follow-up of TLR-MACE.

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