Author + information
- Received October 23, 2013
- Revision received December 18, 2013
- Accepted January 4, 2014
- Published online July 1, 2014.
- David Pereg, MD∗,
- Paul Fefer, MD∗,†,
- Michelle Samuel, BA, MPH∗,
- Rafael Wolff, MD∗,
- Andrew Czarnecki, MD∗,
- Saswata Deb, MD‡,
- John D. Sparkes, MSc∗,
- Stephan E. Fremes, MD‡,§ and
- Bradley H. Strauss, MD, PhD∗,‖∗ ()
- ∗Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- †Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
- ‡Division of Cardiovascular Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- §Bernard S. Goldman Chair in Cardiovascular Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- ‖Reichmann Chair in Cardiovascular Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- ↵∗Reprint requests and correspondence:
Dr. Bradley H. Strauss, Schulich Heart Program, Sunnybrook Health Sciences Centre, Room D-408, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Objectives The aim of the study was to determine native coronary artery patency 1 year after coronary artery bypass grafting and to identify clinical and angiographic predictors for the development of a chronic total occlusion (CTO).
Background In contrast to the large body of information regarding graft patency, data regarding atherosclerosis progression and vessel patency in surgically bypassed native coronary arteries are less clear.
Methods Of the 440 patients who underwent 1-year follow-up angiography as part of the multicenter RAPS (Radial Artery Patency Study), included in our study were 388 patients (88%) for whom angiograms were available for review. Angiograms were reviewed for native coronary artery patency in an independent blinded manner.
Results On the pre-operative angiogram, CTO of at least 1 native coronary vessel was demonstrated in 240 patients (61.9%) having 305 occluded vessels. At 1 year after coronary artery bypass grafting, at least 1 new native coronary artery CTO occurred in 169 patients (43.6%). In 7.5% of patients, the native artery and the graft supplying that territory were both occluded. A new CTO was almost 5 times more likely to occur in coronary vessels with a pre-operative proximal stenosis >90% compared with vessels with proximal stenosis <90% (45.5% vs. 9.5%, respectively, p < 0.001). Patients with a new CTO had significantly more baseline Canadian Cardiovascular Society class 4 angina compared with patients without a new CTO. A new CTO was less likely to occur in the left anterior descending artery (18.4%), supplied by the left internal thoracic artery. When comparing radial artery and saphenous vein grafts, neither the type of graft nor graft patency had any association with native coronary artery occlusion.
Conclusions CTO of surgically bypassed coronary arteries 1 year after coronary artery bypass grafting is extremely common.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2013.
- Revision received December 18, 2013.
- Accepted January 4, 2014.
- American College of Cardiology Foundation