Long-term Follow-up of Coronary Artery Bypass Patients With Preoperative and New Postoperative Native Coronary Artery Chronic Total Occlusion.
Chronic total occlusions (CTOs) of native coronary arteries are a frequent finding among patients who are referred for surgical revascularization with coronary artery bypass grafting (CABG). The long-term clinical significance of native coronary artery CTO identified at baseline and 1 year after CABG is unknown.



All patients who underwent 1-year follow-up angiography as part of the multicentre Radial Artery Patency Study (RAPS) were assessed for late clinical events.



At a mean follow-up of 7.3 ± 2.9 years, the study group of 388 patients had the following outcomes: 39 (10%) deaths, 6 (1.5%) cases of nonfatal myocardial infarction, and 19 (4.9%) cases of percutaneous coronary intervention (PCI). CTO of ≥ 1 native coronary artery in the baseline preoperative coronary angiogram was demonstrated in 240 (61.9%) patients. The composite of all-cause death, nonfatal myocardial infarction, and PCI occurred significantly more often in patients with at least 1 preoperative CTO than in patients without a preoperative CTO (20% vs 11%; P = 0.048). A new native coronary artery CTO 1 year after surgery occurred in 169 (43.6%) patients. The composite of all-cause death, nonfatal myocardial infarction, and PCI occurred significantly more often in patients with a new CTO 1 year after CABG compared with those without a new CTO (21.3% vs 12.8%; P = 0.028).



In patients undergoing CABG, both preoperative CTOs and new CTOs that develop 1 year after surgery are associated with adverse long-term clinical outcomes.
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
David
D
Pereg
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Leviev Heart Center, Sheba Hospital, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel.
Paul
P
Fefer
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Michelle
M
Samuel
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Mony
M
Shuvy
Division of Cardiovascular Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Saswata
S
Deb
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
John D
JD
Sparkes
Division of Cardiovascular Surgery, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Cardiovascular Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
Stephan E
SE
Fremes
Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Cardiovascular Sciences, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. Electronic address: bradley.strauss@sunnybrook.ca.
Bradley H
BH
Strauss
D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence