JC38306

Size: px

Start display at page:

Download "JC38306"

つづるなかきむら
7 years ago
Views:

1 J Cardiol 200 ; 38: 2 Initial Results and Long-Term Outcome of Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Grafting Hisayuki Yukio Hiroshi Hiroshi Masahiro OKADA, MD TSURUMI, MD KASANUKI, MD, FJCC NISHIDA, MD, FJCC ENDO, MD, FJCC Abstract Objectives. The incidence of percutaneous coronary intervention following bypass surgerycoronary artery bypass grafting : CABGis not low, but the outcomes of patients requiring percutaneous coronary intervention after CABG are not well known. Methods. From June 970 to June 2000, 2,98 patients underwent CABG at our institute using 6,747 grafts including 2,875 saphenous vein graftsvg, 3,042 internal thoracic arteryita, 706 gastro-epiploic arterygea, 22 radial arteryra, and 2 others. Three hundred twenty-seven patients underwent subsequent percutaneous coronary intervention in 520 lesions04 SVG, 97 ITA, 2 GEA, 8 RA, 299 native artery. The initial results and long-term outcome following percutaneous coronary intervention in these 520 consecutive procedures were evaluated retrospectively. Results. Percutaneous coronary intervention to arterial grafts were performed mainly within the early post-operative period, whereas percutaneous coronary intervention to vein grafts had two periodic peaks in the early post-operative period and at 7 years after CABG. Procedural success rate of percutaneous coronary intervention was 90% for SVG, 8% for ITA, 58% for GEA, 88% for RA, and 87% for native arteries. Restenosis rate was 56% for SVG, 30% for ITA, 83% for GEA, 83% for RA, and 49% for native arteries. Cardiac events after percutaneous coronary intervention with previous CABG were greater in cases of ITA, followed by native arteries, SVG, GEA and RAp In the early post-operative period, there was no significant difference between ITA and SVG. In the chronic stage, the prognosis of cardiac events after PCI for SVG was worse than for ITA. Conclusions. Percutaneous coronary intervention after CABG requires strategic consideration based on target-specific initial results and long-term outcome. J Cardiol 200 ; 383: 2 Key Words Angioplasty Coronary artery disease Prognosis Follow-up studies Cardiac surgerycoronary artery bypass grafting Interventional cardiology coronary artery bypass grafting : CABG : Departments of Cardiology, and Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Womens Medical University, Tokyo Address for correspondence : OKADA H, MD, Department of Cardiology, The Heart Institute of Japan, Tokyo Womens Medical University, Kawada-cho 8, Shinjuku-ku, Tokyo Manuscript received February 23, 200 ; revised April and May 6, 200 ; accepted May 6, 200

2 2 CABG CABG,2 percutaneous coronary intervention : PCI 36 CABG PCI CABGPCI 7 CABG PCI CABG PCI CABGPCI CABG 2,98 6,747 2,875 3, CABG PCI PCI 75% CABG PCI PCI CABGPCI50% 50% Clinical variables Table Patient characteristics Male/female Ageyr, meansd Rangeyr Prior myocardial infarction Hypertension Diabetes mellitus Hyperlipidemia Smoking Chronic renal failure Hemodialysis Left ventricular ejection fraction 40% Medications Nitrates Calcium antagonists Beta-blockers Warfarin : %. No. of patients n PCICABG PCI PCIPCI Ca 40% CABG PCI 2 t 2 5 Fisher Kaplan-MeierLogrank p 0.05 J Cardiol 200; 38: 2

3 3 Table 2Angiographic success and restenosis rate of percutaneous coronary intervention in overall bypass grafts and native arteries Lesion sites No. of lesions Initial success rate Angiographic follow-up Angiographic restenosis rate Overall SVG ITA GEA RA Native / / /797 6/786 6/ / / /7756 7/5630 5/683 5/683 00/20549 : %. *p0.00. SVGsaphenous vein graft ; ITAinternal thoracic artery ; GEAgastro-epiploic artery; RAradial artery. Table CABG % 2 PCI 520Table 2 3CABG PCI PCI6432% 35668% CABG PCI PCI CABG CABG 7 2 PCI 87% Fig. 4 86%448/ % 38%97/ % % 57 8% 38 2% PCI 526%CABG309% 92 29% PCI 5 58% 80% % 56% 40%49% Table 2 p ; Fig. 2 83%83% Table 2 Fig. 2 p CABG PCI CABG J Cardiol 200; 38: 2

4 4 Fig. Interval between percutaneous coronary intervention and previous coronary artery bypass grafting Upper left: Arterial grafts peaked in the early post-operative periods. Upper right: Saphenous vein grafts peaked in the early post-operative periods and after 7 years. Lower: Native arteries had no peaks. Abbreviation as in Table 2. Fig. 2 Event-free curve after percutaneous coronary intervention in overall bypass grafts and native arteries Cardiac events after percutaneous coronary intervention in arterial grafts were lower than native arteries, and cardiac events after percutaneous coronary intervention in saphenous vein grafts were higher than native arteriesp Cardiac events were most common in the order of internal thoracic arteries, native arteries, saphenous vein grafts, gastro-epiploic arteries and radial arteriesp Abbreviations as in Table 2. PCI 64PCI % PCI398% % 58% 7086% 35% 67%83%00% % 50% Table 3PCI Table 4PCI 7 Fig. 3 J Cardiol 200; 38: 2

5 5 Table 3Angiographic success and restenosis rate in the early post-operative periods and chronic stage Lesion sites No. of lesions n520 Initial success rate Angiographic follow-up Angiographic restenosis rate TVR Early post-operative periods Group: Bypass grafts SVG Ao-os Body Anast ITA Body Anast GEA RA Group: Native arteries LAD LCX RCA LMT Chronic stage Group: Bypass grafts SVG Ao-os Body Anast ITA Body Anast GEA RA Group: Native arteries LAD LCX RCA LMT /286 /00 /00 6/967 49/7070 2/675 37/5469 6/786 3/475 6/875 8/989 0/47 3/300 59/738 3/475 39/4783 7/2277 7/978 7/978 3/300 28/ / /8783 3/587 2/867 /00 7/64 4/667 7/4935 4/233 3/3735 5/683 3/300 3/650 4/850 5/050 2/367 3/5953 /333 8/3946 3/776 0/70 0/70 2/367 7/286 33/655 27/7238 9/369 5/2 / 2/7 2/4 9/7 /4 8/3 2/5 /3 2/3 3/4 0/5 /2 24/3 / 4/8 9/3 /2 /7 2/33 20/27 9/9 : %. *p0.00, **p0.0. Group: PCI in bypass grafts in the early post-operative period. Group PCI in native coronary arteries in the early post-operative period. Group PCI in bypass grafts in the chronic stage. Group PCI in native coronary arteries in the chronic stage. TVRtarget vessel revascularization ; Ao-osaorto-ostial ; Anastanastomosis ; LADleft anterior descending artery ; LCXleft circumflex artery ; RCAright coronary artery ; LMTleft main coronary trunk. Other abbreviations as in Table 2. 7CABG PCI CABG PCI 356 PCI968% PCI % PCI J Cardiol 200; 38: 2

6 6 Table 4Reasons for unsuccessful results of percutaneous coronary intervention after previous coronary artery bypass graftingn72 Reasons Group n23 Group n5 Group n Group n33 Guide wire uncross Balloon uncross Undilatable Dissection Guiding catheter unwedge Distal embolism Recoil Spasm Perforation Proximal tortuosity Acute closure Explanation of the groups as in Table 3. PCIpercutaneous coronary intervention. Fig. 3 Event-free curve in patients undergoing percutaneous coronary intervention in the early postoperative period There was no significant difference between arterial grafts, native arteries and saphenous vein graftsp Fig. 4 Event-free curve in patients undergoing percutaneous coronary intervention in the chronic stage Cardiac events were most common after percutaneous coronary intervention in saphenous vein grafts, and cardiac events after percutaneous coronary intervention in arterial grafts were least common in the chronic stage after coronary artery bypass graftingp Abbreviation as in Table 2. 89% 90%69% 0% 53%67% PCI 87% 48% Table 3PCI p ; Fig %35% J Cardiol 200; 38: 2

7 7 Table 5Predictors of cardiac events by multivariate analysis Clinical data Factors worsening recovery Prior myocardial infarction No. of lesions Interval between CABG and PCI Factors improving recovery Use of stent Beta-blocker p value CABGcoronary artery bypass grafting. Other abbreviation as in Table 4. 46%76% Table 3 CABG PCI CABG PCI Kahn 8 CABG 9,402,07022%Hayashi 6 CABG,40 38% CABG 2, % Kahn 8 PCI 90% PCI 2, % 3, % PCI PCI 45% PCI 9 CABG PCI 4 Table 5 CABGPCI 36 Stephan Corbelli Dorros Hayashi PCI PCI 3 Stephan 3 2 2CABG PCI Weintraub 9 CABG CABG PCI CABG 3,480 CABG 502 9%78%70%PCI 98%9%85%96%8% 69% Nishida 0 CABG CABG67 2 CABG PCI PCI 7 PCI CABG 2 2 3CABG PCI J Cardiol 200; 38: 2

8 8 PCI76 90% 5,6,8 PCI 86% PCI 80% 3 PCI 4 PCI 5,6 35%0% 67% 83%00%PCI 53% 67% PCI PCI PCI 6 7 8,9 CABG CABG PCI 4CABG PCI 80% 50% Dorros 5 7%Corbelli 4 88%Hayashi % 20 57% 20 PCI CABG 2,22 5PCI PCI PCI J Cardiol 200; 38: 2

9 9 PCI PCI PCI % 4660% 46 90% 56% PCI 46 PCI 7 PCI 040% 4, Gruberg PCI 30% PCI PCI PCI PCI CABGPCI CABGPCI PCI PCI PCI 7 PCI PCI PCI CABGPCI J Cardiol 200; 38: 2

10 20 : CABG PCI CABG PCI : CABG 2,986,747 2,875 3, CABG PCI PCIPCI : PCI 7 PCI 90% 8%58%88%87% 56% 30%83%83%49% PCI p : CABG PCI J Cardiol 200; 383:2 Dorros G, Johnson WD, Tector AJ, Schmahl TM, Kalush SL, Janke L : Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting. J Thorac Cardiovasc Surg 984; 87 :726 2Salomon NW, Page US, Bigelow JC, Krause AH, Okies JE, Metzdorff MT : Reoperative coronary surgery : Comparative analysis of 659 patients undergoing primary bypass and 508 patients undergoing reoperative coronary artery bypass. J Thorac Cardiovasc Surg 990; 00: Stephan WJ, OKeefe JH Jr, Piehler JM, McCallister BD, Dahiya RS, Shimshak TM, Ligon RW, Hartzler GO : Coronary angioplasty versus repeat coronary artery bypass grafting for patients with previous bypass surgery. J Am Coll Cardiol 996 ; 28: Corbelli J, Franco I, Hollman J, Simpfendorfer C, Galan K : Percutaneous transluminal coronary angioplasty after previous coronary artery bypass surgery. Am J Cardiol 985; 56: Dorros G, Lewin RF, Mathiak LM, Johnson WD, Brenowitz J, Schmahl T, Tector A: Percutaneous transluminal coronary angioplasty in patients with two or more previous coronary artery bypass grafting operations. Am J Cardiol 988; 6 : Hayashi I, Hosoda Y, Sasakuri S, Satou T, Takazawa K, Yamamoto S: Reoperation and PTCA after coronary artery bypass graft. Rinsho Kyobu Geka 994; 4 :390393in Jpn with Eng abstr 7Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC : Long-term5 to 2 yearsserial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 985; 89 : Kahn JK, Rutherford BD, McConahay DR, Giorgi LV, Johnson WL, Shimshak TM, Hartzler GO : Early postoperative balloon coronary angioplasty for failed coronary artery bypass grafting. Am J Cardiol 990; 66 : Weintraub WS, Jones EL, Craver JM, Guyton RA : Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts. Am J Cardiol 994; 73 :032 0Nishida H, Hirota J, Koyanagi T, Abe R, Nakano K, Endo M, Koyanagi H: Long-term results in,400 patients with coronary artery bypass grafting: Saphenous vein vs arterial grafts. Kyobu Geka 992; 45: in Jpn with Eng abstr Zaidi AR, Hollman JL: Percutaneous angioplasty of internal mammary artery graft stenosis: Case report and discussion. Cathet Cardiovasc Diagn 985; : Shimshak TM, Giorgi LV, Johnson WL, McConahay DR, Rutherford BD, Ligon R, Hartzler GO : Application of percutaneous transluminal coronary angioplasty to the internal mammary artery graft. J Am Coll Cardiol 988 ; 2 : Komiyama N, Nakanishi S, Yanagishita Y, Nishiyama S, Seki A, Watanabe Y, Konishi T, Fuse K : Percutaneous transluminal coronary angioplasty of gastroepiploic artery J Cardiol 200; 38: 2

11 2 graft. Cathet Cardiovasc Diagn 990; 2 :7779 4Crowley ST, Bies RD, Morrison DA, Barbiere CC : Percutaneous transluminal angioplasty of internal mammary arteries in patients with rest angina. Cathet Cardiovasc Diagn 996 ; 38 : Kulkarni NM, Thomas MR : Severe spasm of a radial artery coronary bypass graft during coronary intervention. Catheter Cardiovasc Interv 999; 47 : Bhan A, Gupta V, Choudhary SK, Sharma R, Singh B, Aggarwal R, Bhargava B, Sharma AV, Venugopal P : Radial artery in CABG: Could the early results be comparable to internal mammary artery graft? Ann Thorac Surg 999; 67 : Nishida H, Sato M, Uwabe K, Shiikawa A, Tomizawa Y, Endo M, Koyanagi H : Coronary artery bypass grafting with both internal thoracic arteries and the right gastroepiploic artery. J Cardiovasc Surg 996; 37: Kawachi K, Kitamura S, Morita R, Kondo S, Taniguchi S, Seki T, Kawada T, Hasegawa J, Yoshida Y, Hagiwara H, Niwaya K, Kaneda K : Late results of coronary artery bypass grafting with the internal thoracic artery. Kyobu Geka 992 ; 45 :665670in Jpn with Eng abstr 9Kobayashi H : The internal mammary artery as a graft material for coronary artery bypass surgery : Histopathologic and biochemical studies of its atherosclerotic changes. Nippon Geka Gakkai Zasshi 990 ; 9 : in Jpn with Eng abstr 20 : PTCA 989; 29: Moussa I, Moses J, Colombo A : Atherectomy plus stenting : What do we gain? Semin Interv Cardiol 2000 ; 5 : Gruberg L, Mehran R, Dangas G, Hong MK, Mintz GS, Kornowski R, Lansky AJ, Kent KM, Pinchard AD, Satler LF, Stone GW, Leon MB: Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions. J Am Coll Cardiol 2000; 35 :556 23Baba H, Okawa Y, Koike S, Hashimoto M, Toyama M, Matsumoto K: Management of arterial stenosis after surgical revascularization. Jpn J Vasc Surg 997; 6 :2529in Jpn with Eng abstr 24Hearne SE, Davidson CJ, Zidar JP, Phillips HR, Stack RS, Sketch MH Jr: Internal mammary artery graft angioplasty: Acute and long-term outcome. Cathet Cardiovasc Diagn 998; 44 : Dimas AP, Arora RR, Whitlow PL, Hollman JL, Franco I, Raymond RE, Dorosti K, Simpfendorfer CC : Percutaneous transluminal angioplasty involving internal mammary artery grafts. Am Heart J 99 ; 22: Gruberg L, Dangas G, Mehran R, Hong MK, Waksman R, Mintz GS, Kent KM, Pichard AD, Satler LF, Lansky AJ, Stone GW, Leon MB : Percutaneous revascularization of the internal mammary artery graft: Short- and long-term outcomes. J Am Coll Cardiol 2000; 35 : J Cardiol 200; 38: 2

PTCA CABG 2PTCA & CABG 3 4 PTCA CABG 1 2 3PTCA & CABG 4 5 PTCA CABG follow-up Japanese Circulation Journal Vol. 64, Suppl. IV, 2000

PTCA CABG 2PTCA & CABG 3 4 PTCA CABG 1 2 3PTCA & CABG 4 5 PTCA CABG follow-up Japanese Circulation Journal Vol. 64, Suppl. IV, 2000 19981999 JR PTCACABG 1 2 PTCA 3 PTCA 4 OP-CABG MID-CAB PTCACABG 1 PTCA PTCA CABG 2 1 PTCA PTCA PTCA PTCA PTCA 2CABG CABG CABG CABG 3PTCA CABG Japanese Circulation Journal Vol. 64, Suppl. IV, 2000 1009