title: Bypass to the left coronary artery system may accelerate left main coronary artery negative remodeling and calcification.
abstract: OBJECTIVE
  This study aimed to use intravascular ultrasound (IVUS) data to reveal the mechanism of lesion progression in the native coronary circulation proximal to bypass grafts after coronary artery bypass grafting (CABG).
  
  
  RESULTS
  We reviewed IVUS images in 86 patients with an angiographically significant left main coronary artery (LMCA) stenosis. Overall, 41 patients underwent CABG more than 6 months (mean 8.2 ± 6.1 years) previously and had at least one patent graft to the left coronary artery system. The number of patent grafts to the left coronary artery was 1.4 ± 0.7. Comparing patent graft vs. non-CABG groups, external elastic membrane and lumen areas and remodeling index at the minimum lumen area (MLA) site trended smaller with no difference in the plaque & media area. In addition, patients in the patent graft group had more LMCA calcium whether defined by cross-sectional (arc at the MLA site of 141 ± 109° vs. 88 ± 108°, P = 0.025) or longitudinal measurements (calcium length index, calculated as LMCA calcium length divided by total LMCA length, 0.69 ± 0.38 vs. 0.50 ± 0.42, P = 0.035).
  
  
  CONCLUSIONS
  Negative remodeling may be the main mechanism of lesion progression proximal to a patent bypass graft, and more calcium was found in LMCA after CABG compared with non-CABG patients.
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Yunpeng
authors.initials: Y
authors.lastname: Shang
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Jun
authors.initials: J
authors.lastname: Pu
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Theresa
authors.initials: T
authors.lastname: Franklin-Bond
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Takehisa
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Yakushiji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging*; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography
references.citation: J Am Coll Cardiol. 2006 Jan 3;47(1):216-35
references.pmid: 16386696
references.citation: Circulation. 1991 Mar;83(3):913-26
references.pmid: 1999040
references.citation: Scand J Thorac Cardiovasc Surg. 1981;15(2):187-98
references.pmid: 6977842
references.citation: Am J Physiol Heart Circ Physiol. 2005 Dec;289(6):H2632-40
references.pmid: 16024578
references.citation: Eur Heart J. 1996 Aug;17(8):1192-8
references.pmid: 8869860
references.citation: Am J Cardiol. 2005 Dec 1;96(11):1476-83
references.pmid: 16310425
references.citation: J Am Coll Cardiol. 1997 Feb;29(2):268-74
references.pmid: 9014977
references.citation: J Am Coll Cardiol. 2009 Feb 10;53(6):530-53
references.pmid: 19195618
references.citation: Arterioscler Thromb Vasc Biol. 2001 Feb;21(2):208-13
references.pmid: 11156854
references.citation: Arterioscler Thromb Vasc Biol. 2007 Aug;27(8):1722-8
references.pmid: 17541029
references.citation: J Am Coll Cardiol. 1995 Jun;25(7):1479-85
references.pmid: 7759694
references.citation: Circulation. 1978 Sep;58(3 Pt 2):I194-9
references.pmid: 14740702
references.citation: Atherosclerosis. 2010 Oct;212(2):524-7
references.pmid: 20667407
references.citation: Circ Res. 2006 Jul 7;99(1):86-92
references.pmid: 16741156
references.citation: J Am Coll Cardiol. 2001 Apr;37(5):1478-92
references.pmid: 11300468
references.citation: J Am Coll Cardiol. 2004 Sep 1;44(5):e213-310
references.pmid: 15337239
references.citation: Circulation. 1979 Aug;60(2):250-9
references.pmid: 312703
references.citation: Circulation. 1997 Apr 1;95(7):1791-8
references.pmid: 9107165
references.citation: Circulation. 1995 Apr 1;91(7):1959-65
references.pmid: 7895353
references.citation: N Engl J Med. 1994 May 19;330(20):1431-8
references.pmid: 8159199
references.citation: Am J Cardiol. 1998 Feb 15;81(4):387-91
references.pmid: 9485124
references.citation: J Am Coll Cardiol. 1998 Jan;31(1):126-33
references.pmid: 9426030
references.citation: Circ J. 2007 May;71(5):654-60
references.pmid: 17456987