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Núñez-Gil IJ, Alfonso E, Salinas P, Nombela-Franco L, Ramakrishna H, Jimenez-Quevedo P, Escaned J, Gonzalo N, de Agustin JA, Vivas D, Feltes G, Macaya C, Fernández-Ortiz A. Internal mammary artery graft failure: Clinical features, management, and long-term outcomes. Indian Heart J 2019; 70 Suppl 3:S329-S337. [PMID: 30595285 PMCID: PMC6309709 DOI: 10.1016/j.ihj.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/02/2018] [Accepted: 08/16/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Data on long-term outcomes after internal mammary artery (IMA) coronary graft failure are scarce. Our objective was to describe the clinical characteristics, management, and prognosis after angiographically confirmed IMA graft failure following coronary revascularization. Methods A three-hospital retrospective registry, observational and descriptive, with prospective follow-up of all consecutive cases of IMA graft failure between 2004 and 2014 was conducted. After treatment, clinical and procedural features were compared between those with and without cardiovascular events. Results Fifty-seven patients were included (89% male, mean age: 62 years, at surgery) in the registry. Most patients underwent an IMA angioplasty (percutaneous coronary intervention [PCI], 74%). In nine cases, the PCI failed at the graft level, and seven underwent a native vessel revascularization. Native vessel treatment was performed in 20% of the study subjects, all with stents. Finally, medical management was decided in three cases. Events after treatment for IMA graft failure were frequent (50.8%), during a median follow-up of 7.5 years. Acute presentation (hazard ratioMACE = 1.35; 95% confidence interval (CI): 1.12–3.00, p < 0.01), age of the patient (hazard ratioMACE = 1.85, 95% CI: 1.17–2.11, p < 0.01), presence of diabetes mellitus (hazard ratioMACE = 2.75, 95% CI: 1.13–6.69, p = 0.02), and the management modality used (IMA-simple angioplasty VS IMA-stenting: hazard ratioMACE = 5.5, 95% CI: 1.40–21.15, p = 0.01) displayed prognostic relevance on multivariate analysis. All-cause mortality occurred in 21.1% and presentation as infarction (hazard ratioDEATH = 1.05, 95% CI: 1.01–2.17, p = 0.01), age (hazard ratioDEATH = 9.08, 95% CI: 2.52–32.69, p < 0.01), and left ventricular ejection fraction (hazard ratioDEATH = 3.68, 95% CI: 1.65–8.18, p < 0.01) were independent predictors of the same. Conclusions In this long-term registry, most patients presented with an acute condition (myocardial infarction, progressive angina) within 12 months after surgery. Acute presentation, age, diabetes mellitus, reduced left ventricular ejection fraction, IMA graft failure segment affected, and the management strategy were related with long-term prognosis.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Emilio Alfonso
- Cardiology, Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | - Pablo Salinas
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Cardiology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Javier Escaned
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Nieves Gonzalo
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | - David Vivas
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Gisela Feltes
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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Werenitzky J, Lepori AJ, Clavero MH, Carranza Á, Islas F, de Agustin JA. Arteritis of Takayasu in Western man of 31 years. Eur Heart J 2018; 39:2216. [PMID: 29579184 DOI: 10.1093/eurheartj/ehy131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- José Werenitzky
- Cardiovascular Institute, Hospital Universitario San Carlos, Profesor Martin Lagos s/n, Madrid 28040, Spain
| | - Augusto José Lepori
- Cardiovascular Image Service of Sanatorio Allende, Obispo oro 46, Córdoba 5000, Argentina
| | - Matías Horacio Clavero
- Cardiovascular Image Service of Sanatorio Allende, Obispo oro 46, Córdoba 5000, Argentina
| | - Álvaro Carranza
- Cardiovascular Institute, Hospital Universitario San Carlos, Profesor Martin Lagos s/n, Madrid 28040, Spain
| | - Fabián Islas
- Cardiovascular Institute, Hospital Universitario San Carlos, Profesor Martin Lagos s/n, Madrid 28040, Spain
| | - José Alberto de Agustin
- Cardiovascular Institute, Hospital Universitario San Carlos, Profesor Martin Lagos s/n, Madrid 28040, Spain
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