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Impact of Postprocedural Graft Flow on Outcomes Following Chronic Total Occlusion Intervention in Postcoronary Artery Bypass Graft Patients: A Detailed Angiographic Analysis

Lookup NU author(s): Dr Mohaned Egred

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Abstract

© 2024 Elsevier Inc.Chronic total occlusions (CTOs) are frequent in patients with previous coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is the usual revascularization strategy. Whether or not the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes after CTO-PCI is unknown. We sought to evaluate the impact of post-PCI graft patency on the durability of CTO-PCI. In total, 259 patients with previous CABG who underwent CTO-PCI in 12 international centers in 2019 to 2023 were categorized into “grafted” and “ungrafted” groups based on the presence of graft on a CTO vessel. The grafted group was subdivided into “graft-occluded” and “graft-patent” groups, depending on graft patency. The primary end points were (1) technical success rate, (2) target vessel failure, and (3) CTO failure rates at 1 year. CTO failure was defined as target vessel revascularization and/or significant in-stent restenosis. A total of 199 patients (77%) were in the grafted group. Grafted CTOs showed higher complexity and lower technical success rates (70% vs 80%, p = 0.004) than nongrafted CTOs. Of the grafted CTOs, 140 (70%) were in the grafted-occluded group and 59 (30%) were in the grafted-patent group. The technical success was lower in the former group (65% vs 81%, p = 0.022). An occluded graft was an independent predictor of technical failure (odds ratio 2.04, 95% confidence interval 1.03 to 4.76, p = 0.049) and persistent post-PCI graft patency was a strong independent predictor of CTO failure at 1 year (hazard ratio 5.6, 95% confidence interval 1.2 to 27.5, log-rank p = 0.033). In conclusion, in patients with previous CABG who underwent CTO-PCI, post-PCI graft patency was a significant predictor of CTO failure.


Publication metadata

Author(s): Poletti E, Dens J, Egred M, Munafo AR, Castaldi G, De Cock E, Jossart A, Poels E, Khandaker AH, Lesizza P, Zivelonghi C, Scott B, Haine SEF, Kayaert P, Bataille Y, Cornelis K, Saad G, Coussement P, Bennett J, Droogmans S, Oreglia J, Ungureanu C, Iqbal MB, Agostoni P

Publication type: Article

Publication status: Published

Journal: American Journal of Cardiology

Year: 2024

Volume: 226

Pages: 24-33

Print publication date: 01/09/2024

Online publication date: 15/06/2024

Acceptance date: 10/06/2024

ISSN (print): 0002-9149

ISSN (electronic): 1879-1913

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.amjcard.2024.06.015

DOI: 10.1016/j.amjcard.2024.06.015

PubMed id: 38885921


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