title: Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting: Results from the East Denmark heart registry.
abstract: BACKGROUND
  There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro-vascular coronary disease and it is not known how often targets for intervention are identified.
  
  
  METHODS
  Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014. Clinical and procedural data were prospectively stored in a regional electronic database. Follow-up data were available for all patients, by means of records linked to each Danish social security number.
  
  
  RESULTS
  In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08-3.44], P = 0.027), significant angina (HR 1.49 [1.18-1.88], P = 0.006 for angina class ≥ II, and HR 2.04 [1.61-2.58], P < 0.001 for angina class ≥ III) and a positive pre-procedural stress test (HR 2.56 [1.42-4.60], P < 0.001) were independent predictors of revascularization. Stress testing was, however, used less frequently than in patients without prior CABG (17.2% vs. 24.2%, P < 0.001). The positive predictive values for subsequent revascularization were 47.8%, 51.4%, and 66.9% for exercise ECG, stress echocardiography, and myocardial perfusion scintigraphy (MPS), respectively.
  
  
  CONCLUSIONS
  Invasive angiography leads to revascularization in a quarter of patients with angina and prior CABG; the threshold for referral may be too low. Non-invasive stress testing predicts the need for revascularization but appears underused and MPS, in particular, may better identify patients likely to require revascularization. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Joshi
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Luigi
authors.initials: L
authors.lastname: Biasco
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.affiliation: Gentofte Hospital, Gentofte, Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Abildgaard
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.|Roskilde Hospital, Roskilde, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbaek
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: De Backer
authors.affiliation: Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003718:Denmark; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012042:Registries; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass graft surgery; invasive coronary angiography; stable angina