Development of De Novo Chronic Total Occlusion in Native Coronary Arteries of Coronary Artery Bypass Grafting Surgery Patients

Year 2020, Volume: 4 Issue: 3, 230 - 235, 29.10.2020

Ali Çoner , Sinan Akıncı , Ertan Akbay Ali Baran Budak Tonguç Saba Haldun Müderrisoğlu

https://doi.org/10.30565/medalanya.731636

Cited By: 1

Abstract

Aim: Postoperative de novo chronic total occlusions (CTOs) of preoperatively non-occluded native coronary arteries are commonly seen in coronary artery bypass grafting (CABG) surgery patients in the clinical follow-up; however, data about this course is limited. The aim of this study was to investigate the prevalence of new CTO development in native coronary arteries postoperatively and the clinical factors which may play role in this context.

Methods: A total of 492 CABG patients has been searched from the computer database at Başkent University Hospital Alanya Application and Research Center and patients with a recurrent coronary angiography (CAG) procedure after the first 6 months following surgery were involved in the study population. Recurrent CAG recordings were evaluated for the presence of new CTO development. Logistic regression analysis was used to search the role of demographical and angiographical characteristics in the development of de novo CTOs in native coronary arteries.

Results: Seventy-three CABG patients with recurrent CAG were involved in statistical analysis (Mean age was 65.2 ± 9.8 years; male gender 76.7%). Two hundred eighteen preoperatively non-occluded native coronary arteries were evaluated and 119 new CTOs were detected (54.5% of involved vessels). Preoperative proximal stenosis ≥90% is related to more than 3 times new CTO development (67.8% vs. 22.2%) (p<0.001). Dual antiplatelet therapy (DAPT) is found as a protective factor for the patency of native coronary arteries (HR:-0.259; 95% CI:-0.475 to -0.017; p=0.036).

Conclusion: De novo CTO development in native coronary arteries is commonly seen in CABG patients postoperatively. Significance of preoperative stenosis and absence of DAPT seem to be the essential factors in new CTO occurrence.

Keywords

coronary artery bypass grafting, native coronary arteries, chronic total occlusions

Supporting Institution

Başkent University

Project Number

KA19-442

Thanks

Authors thank to Dr. Taylan Erdem Şahin for his invaluable contributions.

Koroner Arter Bypass Greft Cerrahisi Hastalarının Nativ Koroner Arterlerinde Yeni Kronik Total Oklüzyon Gelişimi

Abstract

Amaç: Koroner arter bypass greftleme (KABG) cerrahisi hastalarının postoperatif klinik takibinde preoperatif olarak tam tıkalı olmayan nativ koroner arterlerin kronik total oklüde (KTO) hale gelmesi sık görülse de, seyriyle ilgili veriler kısıtlıdır. Çalışmamızın amacı postoperatif dönemde nativ koroner arterlerde yeni KTO gelişim sıklığını ve bu konuda rol oynayan faktörleri araştırmaktır.

Yöntem: Başkent Üniversitesi Hastanesi Alanya Uygulama ve Araştırma Merkezi’nde gerçekleştirilen tüm KABG operasyonları bilgisayar sisteminden tarandı ve postoperatif ilk 6 aylık dönemden sonra rekürren koroner anjiyografi (KAG) prosedürü uygulanan hastalar çalışma grubuna alındı. Rekürren KAG görüntüleri yeni KTO gelişimi açısından değerlendirildi ve nativ koroner arterlerde yeni KTO gelişimine yol açan demografik ve anjiyografik özellikler lojistik regresyon analizi kullanılarak test edildi.

Bulgular: Rekürren KAG yapılmış olan 73 KABG hastası istatistiksel analize dahil edildi (Ortalama yaş 65.2 ± 9.8 yıl; erkek cinsiyet %76.7). Preoperatif olarak tam tıkalı olmayan ve greftlenmiş olan 218 nativ koroner arter incelendi ve 119’unda (%54.5) yeni KTO saptandı. Preoperatif proksimal darlığın ≥%90 olması 3 kat daha fazla yeni KTO gelişimi ile ilişkili bulundu (%67.8 vs. %22.2) (p<0.001). İkili antiplatelet tedavisinin nativ koroner arterlerin açıklığını koruyucu rolü olduğu tespit edildi (HR:-0.259; %95 CI:-0.475’den -0.017’ye; p=0.036).

Sonuç: Nativ koroner arterlerde postoperatif yeni KTO gelişimi CABG hastalarında sık görülmektedir. Preoperatif darlığın daha ciddi olması ve ikili antiplatelet tedavinin yokluğu yeni KTO gelişimi için temel faktörler olarak bulundu.

Keywords

koroner arter bypass greftleme, nativ koroner arterler, kronik total oklüzyon

Project Number

KA19-442

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