MedStar Authors catalog › Details for: Optimal revascularization strategies for percutaneous coronary intervention of distal anastomotic lesions after coronary artery bypass surgery.
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Optimal revascularization strategies for percutaneous coronary intervention of distal anastomotic lesions after coronary artery bypass surgery.

by Badr, Salem; Kitabata, Hironori; Dvir, Danny; Torguson, Rebecca; Barbash, Israel M; Loh, Joshua P; Pichard, Augusto D; Waksman, Ron.
Citation: Journal of Interventional Cardiology. 26(4):366-71, 2013 Aug..Journal: Journal of interventional cardiology.ISSN: 0896-4327.Full author list: Badr S; Kitabata H; Dvir D; Torguson R; Barbash IM; Loh JP; Pichard AD; Waksman R.UI/PMID: 23795684.Subject(s): Aged | Aged, 80 and over | Angioplasty, Balloon, Coronary | *Coronary Artery Bypass/ae [Adverse Effects] | Coronary Artery Bypass/mt [Methods] | *Coronary Restenosis/th [Therapy] | Drug-Eluting Stents | Female | *Graft Occlusion, Vascular/th [Therapy] | Humans | Male | Middle Aged | *Percutaneous Coronary Intervention | Reoperation | Retrospective Studies | Saphenous Vein/tr [Transplantation] | Stents | Treatment Outcome | Vascular PatencyInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: http://dx.doi.org/10.1111/joic.12042 (Click here) Abbreviated citation: J. INTERVENT. CARDIOL.. 26(4):366-71, 2013 Aug.Abstract: OBJECTIVE: To determine the best revascularization strategy when treating distal anastomotic lesions.Abstract: 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.Abstract: 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).Abstract: 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.Abstract: 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.

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