title: Nonrevascularizable coronary artery disease following coronary artery bypass graft surgery: a population-based study in Olmsted County, Minnesota.
abstract: OBJECTIVE
  Therapeutic options for patients with recurrent cardiac ischemia after coronary artery bypass surgery may be limited and some patients may be considered nonrevascularizable. To further the understanding of this patient cohort, we performed a population-based study of post-coronary bypass patients who developed recurrent angina.
  
  
  RESULTS
  Patients who underwent coronary artery and bypass graft angiography at Mayo Clinic from 2001 to 2005 were identified. Medical records were reviewed to determine indication for angiography, and angiographic analysis was performed in all patients. Among 133 000 residents of Olmsted County, Minnesota, 347 post-bypass patients with angina underwent coronary angiography from 2001 to 2005. Of these, 177 patients received further revascularization (145 percutaneous coronary intervention and 32 redo coronary artery bypass grafting) and the remaining 170 patients were managed medically. Revascularization was not associated with improvement in all-cause or cardiac mortality. Multivariate analysis identified renal dysfunction, diabetes, and severe left ventricular dysfunction but not the lack of revascularization as predictors of mortality.
  
  
  CONCLUSIONS
  In this population-based study, we identified a yearly incidence range of 17.9-33.2 patients with nonrevascularizable angina after coronary artery bypass grafting per 100 000 population. Further revascularization was not associated with improved mortality or morbidity. Attempts to develop therapeutics for this population must consider the incidence and outcomes of this cohort.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kiernan
authors.forename: Barry A
authors.initials: BA
authors.lastname: Boilson
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Sandhu
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Veronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Barsness
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Robert D
authors.initials: RD
authors.lastname: Simari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D002317:Cardiovascular Agents