LONG TERM FOLLOW UP OF CORONARY BYPASS PATIENTS WITH PRE-OPERATIVE AND NEW POST-OPERATIVE CHRONIC TOTAL OCCLUSIONS

Abstract

Chronic total occlusions (CTOs) of native coronary arteries are a frequent finding among patients with multi-vessel coronary artery disease who are being referred for surgical revascularization with coronary artery bypass grafting (CABG). We have recently demonstrated that among patients 1 year post CABG, at least 1 new native coronary artery CTO was found in 43.6% patients. We aimed to assess the long term clinical significance of native coronary artery CTO identified at baseline and at 1 year post CABG. Study included all patients who underwent 1-year follow-up angiography as part of the multi-centre Radial Artery Patency Study (RAPS). A total of 388 patients, with a mean age of 60±9 years were followed for a median of 7.3 +/- 2.9 years. Adverse events were 39 (10%) deaths, 6 (1.5%) non-fatal myocardial infarctions and 19 (4.9%) underwent PCI. CTO of at least one native coronary artery vessel in the baseline pre-operative coronary angiogram was demonstrated in 240 (61.9%) of patients. The composite endpoint of death from any cause, non-fatal myocardial infarction and repeat coronary revascularization, was significantly increased in patients with at least one pre-operative CTO than in patients without a pre-operative CTO (20% vs 11% respectively, p=0.048). At least 1 new complete native coronary artery occlusion at 1 year post surgery occurred in 169 (43.6%) of patients. The composite endpoint of death from any cause, non-fatal myocardial infarction and repeat coronary revascularization, occurred significantly more often in patients who developed a new CTO at 1 year post CABG compared to those who did not (21.3% and 12.8%, respectively, p=0.028). Among patients undergoing CABG, pre-operative CTOs as well as new CTOs that develop 1 year following surgery are associated with adverse long term clinical outcomes.