IMA Angiography Soon After CABG_ Findings and When to Intervene

  • 格式:pdf
  • 大小:1.36 MB
  • 文档页数:24

51% at 10 Yrs
Galbut
1990
53/947
6
2 M - 15 Y
92
2.7% Non-Surviviors
Mack MJ et al., Ann Thorac Surg 1998;66:1055-9
Late Angiography
One Year After Conventional CABG
Angiography Post MIDCABTM
Significant Narrowing (>50% DS)
55 y.o. woman with recurrent angina 52 days post MIDCAB
Angiography Post MIDCABTM
Total Occlusion
68 y.o. diabetic woman with rest angina day 2 post MIDCAB
Angiography Post
LIMA-LAD MIDCAB 2 days post-op
TM MIDCAB
LIMA-LAD 6 months post-op
POEM Trial
Patency Outcome Economics
Author Schaff Year 1996
#Angio/#OP
% 94
Interval Interop
Patency
Exlclusions/Notes 3 Revised
15/16
100
Calafiore
Subramanian Gill
1998
1997 1997
271/434
169/189 29/29
Background
Angiographic Patency of LIMA • Although conventional coronary artery
bypass grafting (CABG) using the internal mammary artery (IMA) conduit has been performed for the last 20 years, the angiographic appearance and patency of this conduit early postop is not well established. • Most studies report “clinical patency” (freedom from revascularization) rather than angiographic patency.
• Prospective controlled, multicenter
trial for the evaluation of angiographic patency of LIMA to LAD using MIDCAB vs. Conventional CABG
• 400 patients, 200 in each arm • 8 US sites, 1 Canadian
• TIMI flow
Clinical Follow-up @ 6months
CABG MIDCAB n=145 n=165
p
Death (%) MI (%) Clinically driven Revasc (%) CVA (%)
1.5 0.0 0.7 0.7
2.8 0.6 3.0* 1.4
NS NS 0.13 NS
45
20 D
95
Non-Survivors
Geha
Tyras
1979
1980
175/208
527/765 37/40 91/99 25/25 645/831
82
69 92 92 100 78
2W
1M 1M 2W 4-6 H 10.8 D
99
95 97 94 96 98.8
6 Non-Survivors (3%)
Angiography Post MIDCABTM
Aneurysmal Appearance
52 y.o. asymptomatic man 3 days post MIDCAB
Angiography Post MIDCABTM
Distal Anastomosis
59 y.o. asymptomatic man 8 days post MIDCAB (routine pre-d/c angio)
Non-Survivors (1.4%) 2 Non- Survivors, 1 Declined 2 Non-Survivors
Grondin 1984 Invert Gill Berger 1988 1997 1997
>50% stenosis in 7.8%
Mack MJ et al., Ann Thorac Surg 1998;66:1055-9
Berger PB et al., Circulation 1999
Early Angiography
One Month After Conventional CAB
Author Year
#Angio/#OP
%
Interval
Patency
Exlclusions/Notes
Barner
1976
139/307
anastomosis site failure at 6 months Angiographic failure defined as: • >75% diameter stenosis at the anastomosis of the LIMA to LAD and/or < TIMI 3 flow Clinical failure defined as: • Freedom from death, myocardial infarction, major neurologic events, repeat revascularization
Author Year #Angio/#OP % Interval Patency Exlclusions/Notes
Kay
1974
91/628
14
19.5 M
98
1.1% Non-Survivors
Barner
Lytle Tyras Grondin Okies Lytle Loop
1976
1980 1980 1984 1984 1985 1986
Thursday, September 24th, 2009
Disclosures: Roxana Mehran
Clinical Research Support: Sanofi/Aventis, BMS, Bracco Educational Support: The Medicines Company, Boston Scientific, Abbott, Medtronic, and Cordis Consultant/Honoraria: TMC, BSC, Abbott, Medtronic, Sanofi/Aventis, Lilly/Diachi Sankyo, Astra Zeneca, Cordis, Therox, Bracco, Guerbert, Regado
POEM Trial
Inclusion Criteria
• Primary vessel of intervention in both
arms is the LAD (type II) lesion
• Patent LIMA
• Pt suitable for CPB
• Pt agreeable to 6 month angiographic
70/165
43/275 ?/208 88/298 34/?
42
15 49
2 W- 3 Y
9 - 24 M 6M-5Y
97
95 97 94 94
5 Non-Survivors
6 Non-Survivors Suspected failures
29 60 - 108 M ? 3 - 12 Y
Huddleston 1986 914/4140 19 1 M - 11 Y 88@5yr
Hybrid Interventional and Surgical Coronary Revascularization
IMA Angiography Soon After CABG: Findings and When to Intervene
Roxana Mehran, MD Associate Professor of Medicine Columbia University Medical Center Cardiovascular Research Foundation New York City
LMCA, redos, NonSurvivors
Ivert
1988
66/99
67
11 Y
89
Non- Survivors
Mack MJ et al., Ann Thorac Surg 1998;66:1055-9
Graft Patency in Mid-CAB Left Internal Mammary Artery
62
89 100
<1Y
24 – 36 H 4–6H 0 –96 H
94
92 98
4.8 % Grade B
Stenosis = Occlusion +19% stenosis >50%
Mack
1998
100/103
97
99