scholarly journals Percutaneous catheter-based repeat revascularization in patients with previous PCI or CABG: a comprehensive review of the evidence

Vessel Plus ◽  
2022 ◽  
Author(s):  
George Jose Valooran ◽  
Meenakshi Subbiah ◽  
Mohammed Idhrees ◽  
Mukesh Karuppannan ◽  
Mohamad Bashir ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stent Thrombosis ◽  
Artery Bypass ◽  
Target Vessel ◽  
Stent Deployment ◽  
Term Survival ◽  
Repeat Revascularization ◽  
Target Vessel Revascularization

Repeat revascularization after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is one of the most common long-term complications which warrants continuous clinical follow up. Re-interventions negatively impact long-term survival in patients with coronary artery disease. The repeat revascularization after PCI can be either a target lesion revascularization (stent thrombosis/in-stent restenosis) or a revascularization of native coronary artery after PCI (target vessel revascularization/non-target vessel revascularization). The EVENT registry reports that repeat revascularization rates in patients undergoing PCI is 12% in the first year of follow up. Repeat revascularization with additional stent deployment increases the rate of stent thrombosis and restenosis, thereby leading to recurrent ischemic events. Repeat revascularization after CABG can be either in the early postoperative period or later due to native disease progression or late graft stenosis. The need for re-intervention after surgical or percutaneous revascularization is inevitable and is dependent on modifiable and non-modifiable risk factors.

scholarly journals Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Eduardo Bello Martins ◽  
Whady Hueb ◽  
David L. Brown ◽  
Thiago Luis Scudeler ◽  
Eduardo Gomes Lima ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Repeat Revascularization ◽  
Long Term Follow Up

Abstract Background The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. Methods This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. Results In the CABG sample, SSI had a median of 23 (IQR 17–29.5), median SSII of 25.4 (IQR 19.2–32.8), and median rSS of 2 (IQR 0–6.5); in PCI SSI had a median of 14 (IQR 10–19.1), median SSII of 28.7 (IQR 23–34.2), and median rSS of 4.7 (IQR 0–9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13–3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74–10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01–1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. Conclusion Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.

scholarly journals Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Coronary Artery Disease Patients with Advanced Chronic Kidney Disease: A Chinese Single-Center Study

2020 ◽  
Author(s):  
Yang Li ◽  
Hongliang Rui ◽  
Zhuhui Huang ◽  
Xiaoyu Xu ◽  
Taoshuai Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Advanced Chronic Kidney Disease ◽  
Repeat Revascularization ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Objectives Aims to compare the contemporary and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with advanced chronic kidney disease (CKD). Design Observational cohort study, single-center.Setting The largest cardiac surgery center in China.Participants 823 CAD patients with advanced CKD (eGFR<30 ml/min/1.73m2) were collected, including 247 patients who underwent CABG and 576 patients received PCI from January 2010 to February 2019. Main outcome measures The primary end point was all-cause death. The secondary end points included major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), stroke and revascularization.Results Multivariable Cox regression models were used for risk-adjustment and propensity score matching (PSM) was also performed. After PSM, the 30-day mortality rate in the CABG group was higher than that in the PCI group but without statistically significant (6.6%vs2.4%, p=0.0640). During the first year, patients referred for CABG had a hazard ratio (HR) of 1.42 [95% confidence interval (CI), 0.41–3.01] for mortality compared with PCI. At the end of the 5-year follow-up, CABG group had a HR of 0.58 (95%CI, 0.38-0.86) for repeat revascularization, a HR of 0.77 (95%CI, 0.52-1.14) for survival rate and a HR of 0.88(95%CI, 0.56-1.18) for MACCE as compared to PCI. Conclusions Our study suggests that among advanced CKD patients，CABG showed obviously lower risk for repeat revascularization and slightly better prognosis regarding to mortality and other adverse events compared with PCI during the long-term follow-up. At a mean pooled follow-up of one year, both mortality and MACCEs were comparable in both cohorts.

scholarly journals Minimally invasive surgical approaches to left main and left anterior descending coronary artery revascularization are superior compared to first- and second-generation drug-eluting stents: a network meta-analysis

2019 ◽  
Vol 57 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Ben Indja ◽  
Kei Woldendorp ◽  
Deborah Black ◽  
Paul G Bannon ◽  
Michael K Wilson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Second Generation ◽  
Artery Bypass ◽  
Target Vessel ◽  
Left Main ◽  
Off Pump ◽  
Target Vessel Revascularization ◽  
Pump Coronary Artery Bypass

Abstract OBJECTIVES There are a number of minimally invasive approaches to revascularization of coronary artery disease that involve the left main or proximal left anterior descending artery; however, studies to date provide mixed results. METHODS A Bayesian network meta-analysis was performed to compare early and late postoperative outcomes between percutaneous coronary intervention with first- and second-generation drug-eluting stents (DESs), off-pump coronary artery bypass and minimally invasive direct coronary artery bypass (MIDCAB) in patients with involvement of left main or left anterior descending disease. RESULTS A total of 37 studies with 31 728 patients were included in the analysis. There were no significant differences in early mortality rates, strokes or myocardial infarctions (MIs). The long-term all-cause mortality rate was equivalent between the groups. Patients who had off-pump coronary artery bypass had fewer late MI compared with those who had first-generation DES (DES1) [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.20–0.72] and MIDCAB (OR 0.41, 95% CI 0.17–0.97) and reduced late target vessel revascularization compared with DES1 (OR 0.17, 95% CI 0.09–0.32) and second-generation DES (DES2) (OR 0.32, 95% CI 0.14–0.72). The rate of late major adverse cardiac events was lower with off-pump coronary artery bypass compared with that with DES1 (OR 0.33, 95% CI 0.26–0.43) and DES2 (OR 0.62, 95% CI 0.45–0.90). The rate of late major adverse cardiac events with MIDCAB was lower than that with DES1 (OR 0.43, 95% CI 0.31–0.62) as was that with DES2 compared with DES1 (OR 0.53, 95% CI 0.39–0.70). CONCLUSIONS Surgical approaches to left main or proximal left anterior descending disease remain superior to first- or second-generation DES in terms of long-term freedom from MI and target vessel revascularization as well as improved overall long-term survival. Conflicting rates of late MI and target vessel revascularization in patients who underwent MIDCAB suggest disease in alternate vessels that may best be approached via hybrid techniques.

scholarly journals Coronary artery bypass graft surgery versus stenting for patients with chronic kidney disease and complex coronary artery disease: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232199027
Author(s):  
Kongyong Cui ◽  
Hong Liu ◽  
Fei Yuan ◽  
Feng Xu ◽  
Min Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Repeat Revascularization ◽  
Artery Disease

Background: The relative role of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stent implantation in patients with chronic kidney disease (CKD) and complex coronary artery disease (CAD) remains debatable due to the lack of randomized controlled trials (RCTs). We therefore performed this meta-analysis to compare the outcomes of the two strategies in CKD patients with multivessel and/or left main disease. Methods: Electronic databases including PubMed, EMBASE and Cochrane Library were comprehensively searched to identify the eligible subgroup analysis of RCTs and propensity-matched registries. The primary endpoint was all-cause mortality during the longest follow-up. Results: Five subgroup analyses of RCTs and six propensity-matched registries involving 26,441 patients were analyzed. Overall, the strategy of CABG was associated with lower risks of long-term mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74–0.93], myocardial infarction (OR, 0.41; 95% CI, 0.27–0.62), and repeat revascularization (OR, 0.25; 95% CI, 0.16–0.39) compared with PCI in CKD patients with complex CAD. However, CABG was slightly associated with higher risk of stroke than PCI (OR, 1.33; 95% CI, 1.00–1.77). Nonetheless, the higher stroke risk in the CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI, 0.37–2.25) (>3 years). Conclusion: This meta-analysis supports the current guideline advising CABG for patients with CKD and complex CAD. At the expense of slightly increased risk of stroke, CABG reduces the incidences of long-term all-cause death, myocardial infarction and repeat revascularization compared with PCI.

Abstract 3031: Repeat Revascularisation following Multivessel Sirolimus-eluting Stent Implantation: Indications and Long-term Follow-up From the Arterial Revascularisation Therapies Study Part 2 (ARTS-II)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Neville Kukreja ◽  
Patrick Serruys ◽  
Steve Ramcharitar ◽  
Shuzou Tanimoto ◽  
Yoshinobu Onuma ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Disease Progression ◽  
Stent Thrombosis ◽  
Neointimal Hyperplasia ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Target Vessel ◽  
Repeat Revascularization ◽  
Procedural Complications

Objectives: Although coronary-artery bypass grafting (CABG) has been considered the gold standard of treatment for multivessel coronary artery disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may be an alternative: the ARTS-II trial found that after 3 years, the major benefit of CABG was a decreased need for repeat revascularization. We reviewed the angiographic findings in all patients from ARTS-II who required repeat revascularization to investigate their prognosis and to establish the reasons for repeat revascularization in these high risk complex patients, including the relative contributions of procedural complications, neointimal hyperplasia, stent thrombosis, geographical miss and disease progression. Methods: There was no routine angiographic follow-up in ARTS-II. All intercurrent angiograms within 3 years were reviewed. Patients requiring CABG due to index procedural complications or procedural failure were excluded (n = 8). The angiographic indications for repeat revascularization were categorized into target lesion revascularization (TLR), target vessel-non target lesion revascularization (TV-nonTLR) or non-target vessel revascularization (non-TVR). Patients undergoing TLR were further categorized into instent restenosis (ISR) according to the Mehran classification, stent edge restenosis (SER) or definite stent thrombosis (ST). Findings: Within 3 years of the initial treatment, 81/607 patients required 103 repeat revascularizations to treat 150 lesions. These repeat revascularizations were classified as TLR in 74% of lesions, TV-nonTLR in 22% and non-TVR in 4%. The cases of TLR were due to ISR in 59%, SER in 25% and ST in 17%. The majority of ISR cases were Mehran Class IC (focal, body). ISR accounted for 42% of all repeat revascularizations, whilst ST accounted for 11%. Conclusion: Repeat revascularization was due to ISR or ST in approximately half of the lesions; the remainder were due to either incomplete lesion coverage or disease progression. Hard clinical endpoint outcomes of patients stratified by the type of repeat revascularization will be presented at the meeting.

scholarly journals Transfusion of red blood cells: the impact on short-term and long-term survival after coronary artery bypass grafting, a ten-year follow-up

2010 ◽  
Vol 10 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Albert H.M. van Straten ◽  
Margreet W.A. Bekker ◽  
Mohamed A. Soliman Hamad ◽  
André A.J. van Zundert ◽  
Elisabeth J. Martens ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Blood Cells ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Short Term ◽  
Term Survival ◽  
The Impact

scholarly journals Selection of optimal endarterectomy technique in the left anterior descending artery for diffuse coronary atherosclerosis

2021 ◽  
Vol 26 (8) ◽  
pp. 4397
Author(s):  
S. A. Belash ◽  
K. O. Barbukhatti ◽  
S. S. Shevchenko ◽  
E. P. Yasakova ◽  
A. S. Nekrasov ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Long Term Outcomes ◽  
Optimal Method ◽  
Term Survival ◽  
Left Anterior Descending Artery ◽  
Angiographic Data

Aim. To determine the optimal method for performing coronary artery endarterectomy (СE) based on immediate and long-term outcomes of coronary artery bypass grafting (CABG) in combination with open or closed CE in the left anterior descending artery (LAD).Material and methods. This retrospective study included 103 patients who underwent CABG in combination with closed CE and 204 after open CE in the LAD during the period from 2003 to 2016. In both groups, the patient age was comparable (65 years [56; 69] vs 67 years [58; 72] (p=0,263)). There were more men (88,3% vs 81,4% (p=0,421). The mean follow-up period was 94 months [38; 180]. Long-term outcomes were assessed in 86,4% (n=89) and 83,8% (n=171) of patients from the closed and open CE groups, respectively (p=0,141). Angiographic data were studied in 75,3% and 67,3% of patients, respectively (p=0,441).Results. In the closed and open CE groups, in-hospital mortality was 4,8% and 1,5% (p=0,0012), incidence of perioperative myocardial infarction — 11,6% vs 2,5%, (p<0,001), survival rate after 7,8 years — 81,3±5,1% and 84,4±3,2% (p=0,342), respectively. The patency of arterial shunts was significantly higher in the open CE group — 93,1% vs 80,6% (p=0,004). At the same time, the patency of venous shunts in the long-term period between the groups was comparable — 70,1% vs 73,7% (p=0,314).Conclusion. Open CE in combination with CABG provides better immediate outcomes compared to closed CE. Long-term survival and freedom from angina between the groups were comparable. In the long-term period, the patency of internal thoracic artery after open CE is better than after the closed technique. Open CE is a safe and effective method to achieve complete myocardial revascularization in patients with severe diffuse LAD atherosclerosis.

scholarly journals Surgical and Percutaneous Revascularization Outcomes based on SYNTAX I, II, and Residual Scores. A Long-Term follow-up Study.

2021 ◽  
Author(s):  
Eduardo Bello Martins ◽  
Whady Hueb ◽  
David L Brown ◽  
Thiago Luis Scudeler ◽  
Eduardo Gomes Lima ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Repeat Revascularization ◽  
Long Term Follow Up

Abstract BackgroundThe objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up.MethodsThis is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction (MI), stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE.ResultsIn the CABG sample, SSI had a median of 23 (IQR:17-29.5), median SSII of 25.4 (IQR:19.2-32.8), and median rSS of 2 (IQR:0-6.5); in PCI SSI had a median of 14 (IQR:10-19.1), median SSII of 28.7 (IQR:23-34.2), and median rSS of 4.7 (IQR:0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% versus 21.2%; adjusted HR: 1.98; 95% CI, 1.13-3.47; P=.016) and repeat revascularization (3.8% versus 11.5%; adjusted HR: 4.35; CI 95%: 1.74-10.85; P=.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR=1.04; 95% CI, 1.01-1.06; P=.001). Regarding death, the only independent predictors were ejection fraction and renal function.ConclusionSurgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.

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