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Krysztofiak T, Ahmad F, Adams J, Stobo DB, Good R, Byrne J. The value of non-invasive computed tomography coronary angiography in imaging patients with coronary artery bypass grafts. Scott Med J 2020; 65:76-80. [PMID: 32580687 DOI: 10.1177/0036933020936274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Invasive coronary angiography (ICA) is associated with higher complication rates in patients following coronary artery bypass surgery (CABG). CT coronary angiography (CTCA) has emerged as an attractive alternative. We assessed the impact of CTCA on subsequent ICA. METHODS We identified 213 CABG patients undergoing CTCA between 2015 and 2018. In 151 the indication was suspected recurrence of angina. We then identified patients undergoing ICA within 1 year of CTCA. RESULTS CTCA obviated the need for ICA in 115 cases (76%). CTCA was better at identifying targets for percutaneous coronary intervention (PCI) to saphenous vein grafts (SVG's) than to native vessels (89% vs 47%). 7 out of 10 lesions of "probable" significance by CTCA proved flow-limiting, and 4 out of 13 "indeterminate" lesions. CTCA concordance was 97% for left internal mammary (LIMA) grafts. CONCLUSION CTCA directed management in a majority of patients without ICA. It identified a cohort of patients likely to be candidates for SVG PCI, but was less effective in identifying PCI targets in the native vessels. CTCA renders invasive LIMA cannulation redundant unless a target lesion is suspected.
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Affiliation(s)
- T Krysztofiak
- Cardiology Clinical Fellow, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - F Ahmad
- Cardiology Specialist Registrar, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - J Adams
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - D B Stobo
- Consultant Radiologist, Department of Radiology, Golden Jubilee National Hospital, UK
| | - R Good
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - J Byrne
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
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Jovin DG, Katlaps GJ, Sumption KF. Coronary artery bypass graft markers: history, usage, and effects. Gen Thorac Cardiovasc Surg 2020; 68:453-458. [DOI: 10.1007/s11748-020-01325-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/21/2020] [Indexed: 01/09/2023]
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Jones DA, Castle EV, Beirne AM, Rathod KS, Treibel TA, Guttmann OP, Moon JC, Smith EJ, Bourantas CV, Davies LC, Wragg A, Pugliese F, Mathur A. Computed tomography cardiac angiography for planning invasive angiographic procedures in patients with previous coronary artery bypass grafting. EUROINTERVENTION 2020; 15:e1351-e1357. [DOI: 10.4244/eij-d-18-01185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wald DS, Wald BJ, Radford A, Shipolini A. The sternal wire code; Solving the problem of missing coronary artery bypass graft records during cardiac catheterization. IJC HEART & VASCULATURE 2018; 19:37-40. [PMID: 29946562 PMCID: PMC6016071 DOI: 10.1016/j.ijcha.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/17/2018] [Indexed: 11/25/2022]
Abstract
Background The sternal wire code records details of coronary artery bypass surgery (CABG) inside patients, based on the orientation of wires used for sternal closure. Visible on X-ray, the code overcomes the problem of missing graft-notes needed before repeat angiography. We determined (i) the potential value (ii) acceptability and (iii) accuracy of the code in practice. Methods (i) Consecutive coronary angiogram reports (2015–2016 Barts, London) were reviewed to identify patients with previous CABG and those with and without graft-notes before angiography. (ii) UK surgeons were surveyed on whether they would insert the code during CABG. (iii) A clinician, blinded to operative details, interpreted 16 post-CABG X-rays, 8 with the code and 8 without. Results (i) Of 6483 angiography patients, 559 had previous CABG (9.2% (8.5–10%)). Graft-notes were missing in 91/559 (15.1% (12–18%)); almost all (88/91) among patients with acute myocardial infarction. (ii) In the survey, 66/71surgeons (93% (84–98%)) were willing to use the code. (iii) In the accuracy test, all coded X-rays were identified and 28/28 grafts correctly interpreted (p < 0.001). Conclusions About 1 in 6 patients with previous CABG, who require emergency coronary angiography, undergo this procedure without graft-notes and would benefit from the sternal wire code which appears clinically acceptable and accurate.
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Affiliation(s)
- David S Wald
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.,Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Ben J Wald
- Dulwich College, Dulwich Common, London SE21 7LD, United Kingdom
| | - Angus Radford
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
| | - Alex Shipolini
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom
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Christakopoulos GE, Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman MR, Lombardi WL, Tarar MNJ, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh M, Green P, Finn M, Garcia S, Doing AH, Hatem R, Thompson CA, Banerjee S, Brilakis ES. Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry. Can J Cardiol 2016; 33:478-484. [PMID: 28169091 DOI: 10.1016/j.cjca.2016.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury. METHODS We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centres between May 2012 and May 2015. RESULTS The mean age was 65 ± 10 years, 87% of patients were men, and 35% had previous coronary artery bypass graft surgery (CABG). Technical and procedural success was 92% and 90%, respectively. The median patient AK dose was 3.40 (interquartile range, 2.00-5.40) Gy and 34% of the patients received > 4.8 Gy (high radiation exposure). In univariable analysis male sex (P = 0.016), high body mass index (P < 0.001), history of hyperlipidemia (P = 0.023), previous CABG (P < 0.001), moderate or severe calcification (P < 0.001), tortuosity (P < 0.001), proximal cap ambiguity (P = 0.001), distal cap at a bifurcation (P = 0.006), longer CTO occlusion length (P < 0.001), blunt/no blunt stump (P < 0.001), and centre (P < 0.001) were associated with higher patient AK dose. In multivariable analysis high body mass index (P < 0.001), previous CABG (P = 0.005), moderate or severe calcification (P = 0.005), longer CTO occlusion length (P < 0.001), and centre (P < 0.001) were independently associated with higher patient AK dose. CONCLUSIONS Approximately 1 in 3 patients who undergo CTO PCI receive high AK radiation dose (> 4.8 Gy). Several baseline clinical and angiographic characteristics can help predict the likelihood of high radiation dose and assist with intensifying efforts to reduce radiation exposure for the patient and the operator.
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Affiliation(s)
| | | | | | | | - Robert W Yeh
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Santiago Garcia
- Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Raja Hatem
- Columbia University, New York, New York, USA
| | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA; Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
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Plessis J, Warin Fresse K, Cahouch Z, Manigold T, Letocart V, Le Gloan L, Guyomarch B, Guerin P. Value of Image Fusion in Coronary Angiography for the Detection of Coronary Artery Bypass Grafts. J Am Heart Assoc 2016; 5:JAHA.115.002233. [PMID: 27287701 PMCID: PMC4937242 DOI: 10.1161/jaha.115.002233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Coronary angiography is more complex in patients with coronary artery bypass grafts (CABG). Image fusion is a new technology that allows the overlay of a computed tomography (CT) three-dimension (3D) model with fluoroscopic images in real time. METHODS AND RESULTS This single-center prospective study included 66 previous CABG patients undergoing coronary and bypass graft angiography. Image fusion coronary angiographies (fusion group, 20 patients) were compared to conventional coronary angiographies (control group, 46 patients). The fusion group included patients for whom a previous chest CT scan with contrast was available. For patients in this group, aorta and CABG were reconstructed in 3D from CT acquisitions and merged in real time with fluoroscopic images. The following parameters were compared: time needed to localize the CABG; procedure duration; air kerma (AK); dose area product (DAP); and volume of contrast media injected. Results are expressed as median. There were no significant differences between the 2 groups in patient demographics and procedure characteristics (access site, number of bypass to be found, and interventional cardiologist's experience). The time to localize CABG was significantly shorter in the fusion group (7.3 versus 12.4 minutes; P=0.002), as well as the procedure duration (20.6 versus 25.6 minutes; P=0.002), AK (610 versus 814 mGy; P=0.02), DAP (4390 versus 5922.5 cGy·cm(2); P=0.02), and volume of iodinated contrast media (85 versus 116 cc; P=0.002). CONCLUSIONS 3D image fusion improves the CABG detection in coronary angiography and reduces the time necessary to localize CABG, total procedure time duration, radiation exposure, and volume of contrast media.
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Affiliation(s)
- Julien Plessis
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Karine Warin Fresse
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Zachary Cahouch
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Thibaut Manigold
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Vincent Letocart
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Laurianne Le Gloan
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Béatrice Guyomarch
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Patrice Guerin
- Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Christopoulos G, Papayannis AC, Alomar M, Christakopoulos GE, Kotsia A, Michael TT, Rangan BV, Roesle M, Shorrock D, Makke L, Maragkoudakis S, Mohammad A, Sarode K, Chambers CE, Banerjee S, Brilakis ES. Determinants of operator and patient radiation exposure during cardiac catheterization: Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial. Catheter Cardiovasc Interv 2015; 88:1046-1055. [DOI: 10.1002/ccd.26341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/08/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Mohammed Alomar
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Anna Kotsia
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Tesfaldet T. Michael
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Michele Roesle
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Deborah Shorrock
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Lorenza Makke
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Spyros Maragkoudakis
- Department of Cardiovascular Diseases, University of Heraklion; Heraklion Greece
| | - Atif Mohammad
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Karan Sarode
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
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Brilakis ES, Lee M, Mehilli J, Marmagkiolis K, Rodes-Cabau J, Sachdeva R, Kotsia A, Christopoulos G, Rangan BV, Mohammed A, Banerjee S. Saphenous Vein Graft Interventions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:301. [DOI: 10.1007/s11936-014-0301-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Michael TT, Alomar M, Papayannis A, Mogabgab O, Patel VG, Rangan BV, Luna M, Hastings JL, Grodin J, Abdullah S, Banerjee S, Brilakis ES. A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention). JACC Cardiovasc Interv 2013; 6:1138-44. [PMID: 24139930 DOI: 10.1016/j.jcin.2013.08.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/19/2013] [Accepted: 08/26/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery. BACKGROUND Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery. METHODS Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat. RESULTS Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 ± 39 ml vs. 171 ± 72 ml, p < 0.01), longer procedure time (21.9 ± 6.8 min vs. 34.2 ± 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 ± 0.54 Gy vs. 1.29 ± 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 ± 1.0 mrem vs. 2.6 ± 1.7 mrem, p < 0.01; second operator 0.8 ± 1.1 mrem vs. 1.8 ± 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%). CONCLUSIONS In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).
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Affiliation(s)
- Tesfaldet T Michael
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas
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Retrograde wiring: a novel technique for identifying the origin of unusual saphenous vein grafts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:298-300. [DOI: 10.1016/j.carrev.2012.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/21/2012] [Accepted: 06/27/2012] [Indexed: 01/09/2023]
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Abstract
CABG surgery is an effective way to improve symptoms and prognosis in patients with advanced coronary atherosclerotic disease. Despite multiple improvements in surgical technique and patient treatment, graft failure after CABG surgery occurs in a time-dependent fashion, particularly in the second decade after the intervention, in a substantial number of patients because of atherosclerotic progression and saphenous-vein graft (SVG) disease. Until 2010, repeat revascularization by either percutaneous coronary intervention (PCI) or surgical techniques was performed in these high-risk patients in the absence of specific recommendations in clinical practice guidelines, and within a culture of inadequate communication between cardiac surgeons and interventional cardiologists. Indeed, some of the specific technologies developed to reduce procedural risk, such as embolic protection devices for SVG interventions, are largely underused. Additionally, the implementation of secondary prevention, which reduces the need for reintervention in these patients, is still suboptimal. In this Review, graft failure after CABG surgery is examined as a clinical problem from the perspective of holistic patient management. Issues such as the substrate and epidemiology of graft failure, the choice of revascularization modality, the specific problems inherent in repeat CABG surgery and PCI, and the importance of secondary prevention are discussed.
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Affiliation(s)
- Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain.
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Brilakis ES, Rao SV, Banerjee S, Goldman S, Shunk KA, Holmes DR, Honeycutt E, Roe MT. Percutaneous coronary intervention in native arteries versus bypass grafts in prior coronary artery bypass grafting patients: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2011; 4:844-50. [PMID: 21851896 DOI: 10.1016/j.jcin.2011.03.018] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/22/2011] [Accepted: 03/30/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study examined a large registry to determine the frequency, predictors, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery (CABG). BACKGROUND The PCI target vessel and corresponding outcomes in prior CABG patients are poorly studied. METHODS We analyzed the frequency and factors associated with native versus bypass graft PCI in prior CABG patients undergoing PCI between January 1, 2004, and June 30, 2009, in the National Cardiovascular Data Registry (NCDR) CathPCI Registry. Generalized estimating equations logistic regression modeling was used to generate independent variables associated with native versus bypass graft PCI and in-hospital mortality. RESULTS During the study period, PCI in prior CABG patients represented 17.5% of the total PCI volume (300,902 of 1,721,046). The PCI target was a native coronary artery in 62.5% and a bypass graft in 37.5%: saphenous vein graft (SVG) (104,678 [34.9%]), arterial graft (7,517 [2.5%]), or both arterial graft and SVG (718 [0.2%]). Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher-risk characteristics and more procedural complications. On multivariable analysis, several parameters (including graft stenosis and longer interval from CABG) were associated with performing native coronary PCI, and bypass graft PCI was associated with higher in-hospital mortality (adjusted odds ratio: 1.22, 95% confidence interval: 1.12 to 1.32). CONCLUSIONS Most PCIs performed in prior CABG patients are done in native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI is independently associated with higher in-hospital mortality.
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Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical School at Dallas, Dallas, Texas, USA.
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