Percutaneous transluminal angioplasty of saphenous vein grafts for medically refractory unstable angina
Objectives. We attempted to answer the question, Is balloon angioplasty a reasonable alternative to repeat coronary artery bypass graft surgery in patients with previous coronary bypass graft surgery, medically refractory unstable angina and vein graft lesions? Background. Patients with medically re...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1994-04, Vol.23 (5), p.1066-1070 |
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| creator | Morrison, Douglass A. Crowley, Stephen T. Veerakul, Gumpanart Barbiere, Charles C. Grover, Frederick Sacks, Jerome |
| description | Objectives. We attempted to answer the question, Is balloon angioplasty a reasonable alternative to repeat coronary artery bypass graft surgery in patients with previous coronary bypass graft surgery, medically refractory unstable angina and vein graft lesions?
Background. Patients with medically refractory unstable angina need revascularization. Patients with previous coronary artery bypass graft surgery and medically refractory angina are at “high risk” for adverse outcomes with repeat coronary bypass graft surgery. Conversely, patients with angioplasty of old vein grafts are also at “high risk” for adverse outcomes.
Methods. Balloon angioplasty of 89 lesions in saphenous vein grafts was performed in 75 consecutive patients with medically refractory unstable angina. Of these 75 patients, 24 (32%) had myocardial infarct within 30 days, 23 (31%) had left ventricular ejection fraction |
| doi_str_mv | 10.1016/0735-1097(94)90591-6 |
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Background. Patients with medically refractory unstable angina need revascularization. Patients with previous coronary artery bypass graft surgery and medically refractory angina are at “high risk” for adverse outcomes with repeat coronary bypass graft surgery. Conversely, patients with angioplasty of old vein grafts are also at “high risk” for adverse outcomes.
Methods. Balloon angioplasty of 89 lesions in saphenous vein grafts was performed in 75 consecutive patients with medically refractory unstable angina. Of these 75 patients, 24 (32%) had myocardial infarct within 30 days, 23 (31%) had left ventricular ejection fraction <0.35, and 50 (67%) had major comorbidity. Patients underwent standard balloon angioplasty with aggressive use of intravenous and intracoronary heparin, urokinase, nitroglycerin, oral aspirin, calcium channel blocking agents and coumadin.
Results. Angiographic success (reduction of stenosis ≤50% without major complication) was seen in 84 of 89 lesions. Clinical success (angiographic success plus hospital discharge without major complication) was seen in 70 of 75 patients. During index hospitalization, two patients (3%) died, two (3%) had nonfatal infarcts, and one (1%) had emergency reoperation (coronary bypass graft surgery). In late follow up (3 to 66 months), 14 (20%) patients were lost to follow-up, 17 (23%) had repeat percutaneous transluminal coronary angioplasty, 2 (3%) had late bypass graft reoperation, 18 (25%) had late death, and 1 (<1%) had a heart transplant. Of the 41 patients alive after one or more angioplasties, 25 have little or no angina, and 16 have occasional or more angina. We compared long-term survival rate in these 75 patients with a cohort of patients with high risk, unstable angina from the Veterans Affairs Surgical Registry (2,570 patients). The 30-day survival rate was better in patients with coronary angioplasty (97% vs. 92%, p < 0.05), but by 6 months there was no difference, and by 5 years a trend toward a higher survival rate with coronary artery bypass graft surgery was seen.
Conclusions. Balloon angioplasty of saphenous vein grafts with aggressive adjunctive pharmacotherapy is a reasonable alternative to repeat coronary bypass graft surgery in patients with medically refractory unstable angina, previous coronary bypass graft surgery and saphenous vein narrowing.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(94)90591-6</identifier><identifier>PMID: 8144769</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Angina, Unstable - diagnostic imaging ; Angina, Unstable - mortality ; Angina, Unstable - therapy ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Coronary Angiography ; Coronary Artery Bypass ; Diseases of the cardiovascular system ; Humans ; Medical sciences ; Middle Aged ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Reoperation ; Saphenous Vein - transplantation ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 1994-04, Vol.23 (5), p.1066-1070</ispartof><rights>1994</rights><rights>1994 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-73a622c9d328f544afc4397521a7c112aad83d28f48871915b18f3a92224ce613</citedby><cites>FETCH-LOGICAL-c467t-73a622c9d328f544afc4397521a7c112aad83d28f48871915b18f3a92224ce613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0735-1097(94)90591-6$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4067294$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8144769$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morrison, Douglass A.</creatorcontrib><creatorcontrib>Crowley, Stephen T.</creatorcontrib><creatorcontrib>Veerakul, Gumpanart</creatorcontrib><creatorcontrib>Barbiere, Charles C.</creatorcontrib><creatorcontrib>Grover, Frederick</creatorcontrib><creatorcontrib>Sacks, Jerome</creatorcontrib><title>Percutaneous transluminal angioplasty of saphenous vein grafts for medically refractory unstable angina</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives. We attempted to answer the question, Is balloon angioplasty a reasonable alternative to repeat coronary artery bypass graft surgery in patients with previous coronary bypass graft surgery, medically refractory unstable angina and vein graft lesions?
Background. Patients with medically refractory unstable angina need revascularization. Patients with previous coronary artery bypass graft surgery and medically refractory angina are at “high risk” for adverse outcomes with repeat coronary bypass graft surgery. Conversely, patients with angioplasty of old vein grafts are also at “high risk” for adverse outcomes.
Methods. Balloon angioplasty of 89 lesions in saphenous vein grafts was performed in 75 consecutive patients with medically refractory unstable angina. Of these 75 patients, 24 (32%) had myocardial infarct within 30 days, 23 (31%) had left ventricular ejection fraction <0.35, and 50 (67%) had major comorbidity. Patients underwent standard balloon angioplasty with aggressive use of intravenous and intracoronary heparin, urokinase, nitroglycerin, oral aspirin, calcium channel blocking agents and coumadin.
Results. Angiographic success (reduction of stenosis ≤50% without major complication) was seen in 84 of 89 lesions. Clinical success (angiographic success plus hospital discharge without major complication) was seen in 70 of 75 patients. During index hospitalization, two patients (3%) died, two (3%) had nonfatal infarcts, and one (1%) had emergency reoperation (coronary bypass graft surgery). In late follow up (3 to 66 months), 14 (20%) patients were lost to follow-up, 17 (23%) had repeat percutaneous transluminal coronary angioplasty, 2 (3%) had late bypass graft reoperation, 18 (25%) had late death, and 1 (<1%) had a heart transplant. Of the 41 patients alive after one or more angioplasties, 25 have little or no angina, and 16 have occasional or more angina. We compared long-term survival rate in these 75 patients with a cohort of patients with high risk, unstable angina from the Veterans Affairs Surgical Registry (2,570 patients). The 30-day survival rate was better in patients with coronary angioplasty (97% vs. 92%, p < 0.05), but by 6 months there was no difference, and by 5 years a trend toward a higher survival rate with coronary artery bypass graft surgery was seen.
Conclusions. Balloon angioplasty of saphenous vein grafts with aggressive adjunctive pharmacotherapy is a reasonable alternative to repeat coronary bypass graft surgery in patients with medically refractory unstable angina, previous coronary bypass graft surgery and saphenous vein narrowing.</description><subject>Aged</subject><subject>Angina, Unstable - diagnostic imaging</subject><subject>Angina, Unstable - mortality</subject><subject>Angina, Unstable - therapy</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass</subject><subject>Diseases of the cardiovascular system</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Reoperation</subject><subject>Saphenous Vein - transplantation</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1994</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1rGzEQhkVpSNw0_6ABHUpoD5tqtFppdQmE0I9AIDkkZzHWal0VWetK2oD_feXY-NjTHN5nXmYeQj4BuwYG8htTbdcA0-qLFl816zQ08h1ZQNf1Tdtp9Z4sjsgZ-ZDzH8aY7EGfktMehFBSL8jqySU7F4xumjMtCWMO89pHDBTjyk-bgLls6TTSjJvfLu6oV-cjXSUcS6bjlOjaDd5iCFua3JjQlilt6RxzwWVwbzURP5KTEUN2F4d5Tl5-fH---9U8PP68v7t9aKyQqjSqRcm51UPL-7ETAkcrWq06DqgsAEcc-naomeh7BRq6JfRji5pzLqyT0J6Tq33vJk1_Z5eLWftsXQj7D42SggOXqoJiD9o05VwPN5vk15i2BpjZ-TU7eWYnz2hh3vwaWdcuD_3zsv59XDoIrfnnQ465Oqk6ovX5iAkmFdeiYjd7zFUXr94lk6130VaTydlihsn__45_i4KYFg</recordid><startdate>19940401</startdate><enddate>19940401</enddate><creator>Morrison, Douglass A.</creator><creator>Crowley, Stephen T.</creator><creator>Veerakul, Gumpanart</creator><creator>Barbiere, Charles C.</creator><creator>Grover, Frederick</creator><creator>Sacks, Jerome</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19940401</creationdate><title>Percutaneous transluminal angioplasty of saphenous vein grafts for medically refractory unstable angina</title><author>Morrison, Douglass A. ; Crowley, Stephen T. ; Veerakul, Gumpanart ; Barbiere, Charles C. ; Grover, Frederick ; Sacks, Jerome</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-73a622c9d328f544afc4397521a7c112aad83d28f48871915b18f3a92224ce613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1994</creationdate><topic>Aged</topic><topic>Angina, Unstable - diagnostic imaging</topic><topic>Angina, Unstable - mortality</topic><topic>Angina, Unstable - therapy</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass</topic><topic>Diseases of the cardiovascular system</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Reoperation</topic><topic>Saphenous Vein - transplantation</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morrison, Douglass A.</creatorcontrib><creatorcontrib>Crowley, Stephen T.</creatorcontrib><creatorcontrib>Veerakul, Gumpanart</creatorcontrib><creatorcontrib>Barbiere, Charles C.</creatorcontrib><creatorcontrib>Grover, Frederick</creatorcontrib><creatorcontrib>Sacks, Jerome</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morrison, Douglass A.</au><au>Crowley, Stephen T.</au><au>Veerakul, Gumpanart</au><au>Barbiere, Charles C.</au><au>Grover, Frederick</au><au>Sacks, Jerome</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Percutaneous transluminal angioplasty of saphenous vein grafts for medically refractory unstable angina</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1994-04-01</date><risdate>1994</risdate><volume>23</volume><issue>5</issue><spage>1066</spage><epage>1070</epage><pages>1066-1070</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Objectives. We attempted to answer the question, Is balloon angioplasty a reasonable alternative to repeat coronary artery bypass graft surgery in patients with previous coronary bypass graft surgery, medically refractory unstable angina and vein graft lesions?
Background. Patients with medically refractory unstable angina need revascularization. Patients with previous coronary artery bypass graft surgery and medically refractory angina are at “high risk” for adverse outcomes with repeat coronary bypass graft surgery. Conversely, patients with angioplasty of old vein grafts are also at “high risk” for adverse outcomes.
Methods. Balloon angioplasty of 89 lesions in saphenous vein grafts was performed in 75 consecutive patients with medically refractory unstable angina. Of these 75 patients, 24 (32%) had myocardial infarct within 30 days, 23 (31%) had left ventricular ejection fraction <0.35, and 50 (67%) had major comorbidity. Patients underwent standard balloon angioplasty with aggressive use of intravenous and intracoronary heparin, urokinase, nitroglycerin, oral aspirin, calcium channel blocking agents and coumadin.
Results. Angiographic success (reduction of stenosis ≤50% without major complication) was seen in 84 of 89 lesions. Clinical success (angiographic success plus hospital discharge without major complication) was seen in 70 of 75 patients. During index hospitalization, two patients (3%) died, two (3%) had nonfatal infarcts, and one (1%) had emergency reoperation (coronary bypass graft surgery). In late follow up (3 to 66 months), 14 (20%) patients were lost to follow-up, 17 (23%) had repeat percutaneous transluminal coronary angioplasty, 2 (3%) had late bypass graft reoperation, 18 (25%) had late death, and 1 (<1%) had a heart transplant. Of the 41 patients alive after one or more angioplasties, 25 have little or no angina, and 16 have occasional or more angina. We compared long-term survival rate in these 75 patients with a cohort of patients with high risk, unstable angina from the Veterans Affairs Surgical Registry (2,570 patients). The 30-day survival rate was better in patients with coronary angioplasty (97% vs. 92%, p < 0.05), but by 6 months there was no difference, and by 5 years a trend toward a higher survival rate with coronary artery bypass graft surgery was seen.
Conclusions. Balloon angioplasty of saphenous vein grafts with aggressive adjunctive pharmacotherapy is a reasonable alternative to repeat coronary bypass graft surgery in patients with medically refractory unstable angina, previous coronary bypass graft surgery and saphenous vein narrowing.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8144769</pmid><doi>10.1016/0735-1097(94)90591-6</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Angina, Unstable - diagnostic imaging Angina, Unstable - mortality Angina, Unstable - therapy Angioplasty, Balloon, Coronary Biological and medical sciences Coronary Angiography Coronary Artery Bypass Diseases of the cardiovascular system Humans Medical sciences Middle Aged Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Reoperation Saphenous Vein - transplantation Survival Rate Treatment Outcome |
| title | Percutaneous transluminal angioplasty of saphenous vein grafts for medically refractory unstable angina |
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