Impact of Postprocedural Graft Flow on Outcomes Following Chronic Total Occlusion Intervention in Postcoronary Artery Bypass Graft Patients: A Detailed Angiographic Analysis

Chronic total occlusions (CTOs) are frequent in patients with previous coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is the usual revascularization strategy. Whether or not the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes aft...

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Published in:The American journal of cardiology 2024-09, Vol.226, p.24-33
Main Authors: Poletti, Enrico, Dens, Jo, Egred, Mohaned, Munafò, Andrea Raffaele, Castaldi, Gianluca, De Cock, Emmanuel, Jossart, Adrien, Poels, Ella, Khandaker, Azizul Hasan, Lesizza, Pierluigi, Zivelonghi, Carlo, Scott, Benjamin, Haine, Steven Els Frans, Kayaert, Peter, Bataille, Yoann, Cornelis, Kristoff, Saad, Georges, Coussement, Patrick, Bennett, Johan, Droogmans, Steven, Oreglia, Jacopo, Ungureanu, Claudiu, Iqbal, M Bilal, Agostoni, Pierfrancesco
Format: Article
Language:English
Subjects:
Atherosclerosis
Blood vessels
Bypass
Cardiovascular disease
chronic total occlusion
Competition
competitive flow
Coronary artery
coronary artery bypass grafting
Coronary vessels
Failure
Graft-versus-host reaction
Grafting
Heart attacks
Heart surgery
Hemodynamics
Impact analysis
Implants
Occlusion
Patients
percutaneous coronary intervention
Regression analysis
Restenosis
Shear stress
Variables
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Summary:Chronic total occlusions (CTOs) are frequent in patients with previous coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is the usual revascularization strategy. Whether or not the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes after CTO-PCI is unknown. We sought to evaluate the impact of post-PCI graft patency on the durability of CTO-PCI. In total, 259 patients with previous CABG who underwent CTO-PCI in 12 international centers in 2019 to 2023 were categorized into “grafted” and “ungrafted” groups based on the presence of graft on a CTO vessel. The grafted group was subdivided into “graft-occluded” and “graft-patent” groups, depending on graft patency. The primary end points were (1) technical success rate, (2) target vessel failure, and (3) CTO failure rates at 1 year. CTO failure was defined as target vessel revascularization and/or significant in-stent restenosis. A total of 199 patients (77%) were in the grafted group. Grafted CTOs showed higher complexity and lower technical success rates (70% vs 80%, p = 0.004) than nongrafted CTOs. Of the grafted CTOs, 140 (70%) were in the grafted-occluded group and 59 (30%) were in the grafted-patent group. The technical success was lower in the former group (65% vs 81%, p = 0.022). An occluded graft was an independent predictor of technical failure (odds ratio 2.04, 95% confidence interval 1.03 to 4.76, p = 0.049) and persistent post-PCI graft patency was a strong independent predictor of CTO failure at 1 year (hazard ratio 5.6, 95% confidence interval 1.2 to 27.5, log-rank p = 0.033). In conclusion, in patients with previous CABG who underwent CTO-PCI, post-PCI graft patency was a significant predictor of CTO failure. •Enhanced complexity in grafted vessel lesions impacts procedural success.•Patent grafts correlate with improved immediate procedural outcomes.•Graft patency after chronic total occlusions (CTO)-percutaneous coronary intervention predicts CTO failure at follow-up.•Intentional closure of patent grafts may be beneficial after CTO-percutaneous coronary intervention .
ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2024.06.015