Coronary angiographic characteristics of 997 patients with symptomatic recurrence after coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Xiaolong ¹ ,  WANG Jiangang ² , DONG Ran ³ , DANG Haiming ³ , WU Lisong ³ , CAO Jian ³ , KONG Qingyu ¹ , LIANG Lin ¹ , XIAO Wei ¹ , LIU Jiaji ¹ ,  CHI Liqun ¹

1. Minimally Invasive Cardiac Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;
2. Cardiac Valve Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;
3. Coronary Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

WANG Jiangang, Email: jiangangwang@ccmu.edu.cn; CHI Liqun, Email: chiliqun2002@qq.com

Keywords：

Symptomatic recurrence; prior coronary artery bypass grafting; coronary angiography

DOI：

10.7507/1007-4848.202108042

Video：

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Objective To explore coronary angiographic characteristics in patients with symptomatic recurrence after coronary artery bypass grafting (CABG). Methods We performed a retrospective study of 997 patients with symptomatic recurrence after CABG in Beijing Anzhen Hospital from 2010 to 2020. There were 762 males and 235 females, with an average age of 62.41±8.70 years.Results There was a high prevalence of risk factors like hypertension, diabetes and a history of smoking. Diseased arterial grafts accounted for 27.44% while saphenous vein graft 54.40%; 240 (24.07%) patients had all patent grafts. The main lesion characteristics of diseased grafts were chronic total occlusion lesions (79.57%). Most patients had more diseased native vessels after CABG than before. The type C coronary artery disease in native vessels relevant to ischemic area occurred in 674 (67.60%) patients; 525 (52.66%) patients with recurrent symptom after CABG had both diseased grafts and diseased native vessels. Conclusion Graft status in patients with symptomatic recurrence after CABG is worse than we expected. The majority have newly developed lesions both in grafts and native vessels. Native vascular lesions will continue to progress after CABG.

Citation： MA Xiaolong, WANG Jiangang, DONG Ran, DANG Haiming, WU Lisong, CAO Jian, KONG Qingyu, LIANG Lin, XIAO Wei, LIU Jiaji, CHI Liqun. Coronary angiographic characteristics of 997 patients with symptomatic recurrence after coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1156-1160. doi: 10.7507/1007-4848.202108042 Copy

1.	Palmerini T, Serruys P, Kappetein AP, et al. Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4, 686 patients. Am Heart J, 2017, 190: 54-63.
2.	Habib RH, Dimitrova KR, Badour SA, et al. CABG versus PCI: Greater benefit in long-term outcomes with multiple arterial bypass grafting. J Am Coll Cardiol, 2015, 66(13): 1417-1427.
3.	Kirmani BH, Brazier A, Sriskandarajah S, et al. Long-term survival after off-pump coronary artery bypass grafting. Ann Thorac Surg, 2016, 102(1): 22-27.
4.	Raja SG, Benedetto U, Chudasama D, et al. Long-term follow-up of off-pump and on-pump coronary artery bypass grafting. Innovations (Phila), 2014, 9(2): 122-129.
5.	Korbmacher B, Ulbrich S, Dalyanoglu H, et al. Perioperative and long-term development of anxiety and depression in CABG patients. Thorac Cardiovasc Surg, 2013, 61(8): 676-681.
6.	Wann S, Balkhy H. Evaluation of patients after coronary artery bypass grafting. Cardiol Rev, 2009, 17(4): 176-180.
7.	Herlitz J, Brandrup-Wognsen G, Haglid M, et al. Symptoms of chest pain and dyspnea and factors associated with chest pain after coronary artery bypass grafting. Cardiology, 1999, 91(4): 220-226.
8.	Sørgaard MH, Kofoed KF, Linde JJ, et al. Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis. J Cardiovasc Comput Tomogr, 2016, 10(6): 450-457.
9.	de Graaf FR, van Velzen JE, Witkowska AJ, et al. Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting. Eur Radiol, 2011, 21(11): 2285-2296.
10.	Ma X, Chen P, Zhao Y, et al. Coronary angiography characteristics of symptomatic patients with prior coronary artery bypass graft: A descriptive study. Biomed Res Int, 2019, 2019: 1832128.
11.	Jiangping S, Zhe Z, Wei W, et al. Assessment of coronary artery stenosis by coronary angiography: A head-to-head comparison with pathological coronary artery anatomy. Circ Cardiovasc Interv, 2013, 6(3): 262-268.
12.	Markus HS, Larsson SC, Dennis J, et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: The VIST RCT. Health Technol Assess, 2019, 23(41): 1-30.
13.	Paul TK, Sivanesan K, Schulman-Marcus J. Sex differences in nonobstructive coronary artery disease: Recent insights and substantial knowledge gaps. Trends Cardiovasc Med, 2017, 27(3): 173-179.
14.	Menotti A, Puddu PE, Maiani G, et al. Lifestyle behaviour and lifetime incidence of heart diseases. Int J Cardiol, 2015, 201: 293-299.
15.	Rieckmann N, Neumann K, Feger S, et al. Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain. Health Qual Life Outcomes, 2020, 18(1): 140.
16.	仲肇基, 郑哲, 王小啟, 等. 糖尿病患者行双侧乳内动脉冠状动脉旁路移植术早期结果分析. 中国胸心血管外科临床杂志, 2018, 25(7): 1038-1042.Stewart RAH, Held C, Krug-Gourley S, et al. Cardiovascular and lifestyle risk factors and cognitive function in patients with stable coronary heart disease. J Am Heart Assoc, 2019, 8(7): e010641.
17.	Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: The STRENGTH randomized clinical trial. JAMA, 2020, 324(22): 2268-2280.
18.	Nakahara T, Dweck MR, Narula N, et al. Coronary artery calcification: From mechanism to molecular imaging. JACC Cardiovasc Imaging, 2017, 10(5): 582-593.
19.	Gaudino M, Antoniades C, Benedetto U, et al. Mechanisms, consequences, and prevention of coronary graft failure. Circulation, 2017, 136(18): 1749-1764.
20.	Scarsini R, Zivelonghi C, Pesarini G, et al. Repeat revascularization: Percutaneous coronary intervention after coronary artery bypass graft surgery. Cardiovasc Revasc Med, 2016, 17(4): 272-278.
21.	Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a department of veterans affairs cooperative study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
22.	Tinica G, Chistol RO, Bulgaru Iliescu D, et al. Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique. Exp Ther Med, 2019, 17(1): 359-367.
23.	Panh L, Lairez O, Ruidavets JB, et al. Coronary artery calcification: From crystal to plaque rupture. Arch Cardiovasc Dis, 2017, 110(10): 550-561.
24.	Gassett AJ, Sheppard L, McClelland RL, et al. Risk factors for long-term coronary artery calcium progression in the multi-ethnic study of atherosclerosis. J Am Heart Assoc, 2015, 4(8): e001726.
25.	Ebrahimi R, Bakaeen FG, Uberoi A, et al. Effect of clopidogrel use post coronary artery bypass surgery on graft patency. Ann Thorac Surg, 2014, 97(1): 15-21.
26.	Gao G, Zheng Z, Pi Y, et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial. J Am Coll Cardiol, 2010, 56(20): 1639-1643.

1. Palmerini T, Serruys P, Kappetein AP, et al. Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4, 686 patients. Am Heart J, 2017, 190: 54-63.
2. Habib RH, Dimitrova KR, Badour SA, et al. CABG versus PCI: Greater benefit in long-term outcomes with multiple arterial bypass grafting. J Am Coll Cardiol, 2015, 66(13): 1417-1427.
3. Kirmani BH, Brazier A, Sriskandarajah S, et al. Long-term survival after off-pump coronary artery bypass grafting. Ann Thorac Surg, 2016, 102(1): 22-27.
4. Raja SG, Benedetto U, Chudasama D, et al. Long-term follow-up of off-pump and on-pump coronary artery bypass grafting. Innovations (Phila), 2014, 9(2): 122-129.
5. Korbmacher B, Ulbrich S, Dalyanoglu H, et al. Perioperative and long-term development of anxiety and depression in CABG patients. Thorac Cardiovasc Surg, 2013, 61(8): 676-681.
6. Wann S, Balkhy H. Evaluation of patients after coronary artery bypass grafting. Cardiol Rev, 2009, 17(4): 176-180.
7. Herlitz J, Brandrup-Wognsen G, Haglid M, et al. Symptoms of chest pain and dyspnea and factors associated with chest pain after coronary artery bypass grafting. Cardiology, 1999, 91(4): 220-226.
8. Sørgaard MH, Kofoed KF, Linde JJ, et al. Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis. J Cardiovasc Comput Tomogr, 2016, 10(6): 450-457.
9. de Graaf FR, van Velzen JE, Witkowska AJ, et al. Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting. Eur Radiol, 2011, 21(11): 2285-2296.
10. Ma X, Chen P, Zhao Y, et al. Coronary angiography characteristics of symptomatic patients with prior coronary artery bypass graft: A descriptive study. Biomed Res Int, 2019, 2019: 1832128.
11. Jiangping S, Zhe Z, Wei W, et al. Assessment of coronary artery stenosis by coronary angiography: A head-to-head comparison with pathological coronary artery anatomy. Circ Cardiovasc Interv, 2013, 6(3): 262-268.
12. Markus HS, Larsson SC, Dennis J, et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: The VIST RCT. Health Technol Assess, 2019, 23(41): 1-30.
13. Paul TK, Sivanesan K, Schulman-Marcus J. Sex differences in nonobstructive coronary artery disease: Recent insights and substantial knowledge gaps. Trends Cardiovasc Med, 2017, 27(3): 173-179.
14. Menotti A, Puddu PE, Maiani G, et al. Lifestyle behaviour and lifetime incidence of heart diseases. Int J Cardiol, 2015, 201: 293-299.
15. Rieckmann N, Neumann K, Feger S, et al. Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain. Health Qual Life Outcomes, 2020, 18(1): 140.
16. 仲肇基, 郑哲, 王小啟, 等. 糖尿病患者行双侧乳内动脉冠状动脉旁路移植术早期结果分析. 中国胸心血管外科临床杂志, 2018, 25(7): 1038-1042.Stewart RAH, Held C, Krug-Gourley S, et al. Cardiovascular and lifestyle risk factors and cognitive function in patients with stable coronary heart disease. J Am Heart Assoc, 2019, 8(7): e010641.
17. Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: The STRENGTH randomized clinical trial. JAMA, 2020, 324(22): 2268-2280.
18. Nakahara T, Dweck MR, Narula N, et al. Coronary artery calcification: From mechanism to molecular imaging. JACC Cardiovasc Imaging, 2017, 10(5): 582-593.
19. Gaudino M, Antoniades C, Benedetto U, et al. Mechanisms, consequences, and prevention of coronary graft failure. Circulation, 2017, 136(18): 1749-1764.
20. Scarsini R, Zivelonghi C, Pesarini G, et al. Repeat revascularization: Percutaneous coronary intervention after coronary artery bypass graft surgery. Cardiovasc Revasc Med, 2016, 17(4): 272-278.
21. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a department of veterans affairs cooperative study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
22. Tinica G, Chistol RO, Bulgaru Iliescu D, et al. Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique. Exp Ther Med, 2019, 17(1): 359-367.
23. Panh L, Lairez O, Ruidavets JB, et al. Coronary artery calcification: From crystal to plaque rupture. Arch Cardiovasc Dis, 2017, 110(10): 550-561.
24. Gassett AJ, Sheppard L, McClelland RL, et al. Risk factors for long-term coronary artery calcium progression in the multi-ethnic study of atherosclerosis. J Am Heart Assoc, 2015, 4(8): e001726.
25. Ebrahimi R, Bakaeen FG, Uberoi A, et al. Effect of clopidogrel use post coronary artery bypass surgery on graft patency. Ann Thorac Surg, 2014, 97(1): 15-21.
26. Gao G, Zheng Z, Pi Y, et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial. J Am Coll Cardiol, 2010, 56(20): 1639-1643.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Coronary angiographic characteristics of 997 patients with symptomatic recurrence after coronary artery bypass grafting

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