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Permanent link (DOI): https://doi.org/10.7939/R3N58D08B

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Clinical and Angiographic Outcomes Associated with Surgical Revascularization of Angiographically Borderline 50-69% Coronary Artery Stenoses Open Access

Descriptions

Other title
Subject/Keyword
coronary artery stenosis
coronary artery disease
coronary artery bypass grafting
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
Senaratne, Janek M
Supervisor and department
Dr. Craig Butler, Department of Medicine
Dr. Sean Van Diepen, Department of Critical Care Medicine
Examining committee member and department
Dr. Dave Zygun, Department of Critical Care Medicine
Dr. Jeevan Nagendran, Department of Surgery
Department
Department of Medicine
Specialization
Translational Medicine
Date accepted
2017-05-18T14:48:47Z
Graduation date
2017-11:Fall 2017
Degree
Master of Science
Degree level
Master's
Abstract
Objectives: Coronary artery bypass grafting improves outcomes in patients with multi-vessel coronary artery disease. Bypass of angiographically significant lesions ≥70% is recommended, yet little is known about the incidence/outcomes with bypasses of 50-69% angiographically borderline lesions without fractional flow reserve testing. The objective of this study was to investigate the incidence and outcomes of bypass of 50-69% angiographically borderline lesions. Methods: Between 2007 and 2013, 3,195 patients underwent isolated first multi-vessel coronary artery bypass grafting at the Mazankowski Alberta Heart Institute. Patients with an isolated angiographically borderline lesion of a major epicardial vessel were included. The primary analysis compared clinical and angiographic outcomes between patients with and without coronary bypasses of angiographically borderline lesions. Outcomes of interest included time to all-cause mortality, 30 day, and 1 year mortality. Results: Among 350 patients with an angiographically borderline lesion, 268 (76.6%) had the vessel containing the angiographically borderline lesion bypassed while 82 (23.4%) did not. Mean follow-up was 4.2 years. Patients with a bypassed angiographically borderline lesion were older (66.1 vs 62.5 mean years, p=0.006) but otherwise similar in sex, comorbidities, diabetes, ejection fraction, and number of coronary stenoses. Cardiopulmonary bypass time was longer in patients with bypassed angiographically borderline lesions (104.2 versus 90.4 minutes, mean, p<0.001). Unadjusted overall mortality through end of follow-up was higher among patients with bypassed angiographically borderline lesions (11.6% versus 3.7%, p=0.034). After multi-variable adjustment, the association between angiographically borderline lesion bypass and mortality was attenuated (hazard ratio 2.84: 95% confidence interval, 0.87 – 9.23, p=0.080). No differences were observed in unadjusted 30-day (1.1% versus 0.0%, p=0.336) or 1-year mortality (4.1% versus 0.0%, p=0.062). Repeat revascularization of patients with bypassed angiographically borderline lesions was numerically higher (4.1% versus 0.0%, p = 0.107). Conclusions: In an unselected cohort of patients with angiographically borderline lesions, bypass of borderline 50-69% lesions is frequently performed and not associated with improved long-term survival. Our findings suggest that the routine surgical revascularization of 50-69% angiographically borderline lesions may not be warranted.
Language
English
DOI
doi:10.7939/R3N58D08B
Rights
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Senaratne J., Norris C., Graham M., Nagendran J., Freed D., Afilalo J., Van Diepen S. (2016) Clinical and angiographic outcomes associated with surgical revascularization of angiographically borderline 50-69% coronary artery stenosis. European Journal of Cardiothoracic Surgery. 49:e112-e118.

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