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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 268-275, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting. Long-term results

SM Ernst, TA van der Feltz, CA Ascoop, ET Bal, FE Vermeulen, PJ Knaepen, L van Bogerijen, EJ van den Berg and HW Plokker

In 83 patients with previous coronary artery bypass grafting, 92 percutaneous transluminal coronary angioplasty attempts were done, 33 in a venous bypass graft (success rate 97%) and 59 in a native coronary artery (success rate 86.4%). There were no procedural-related deaths and two myocardial infarctions. Forty-six percent of the patients with successful angioplasty after previous bypass grafting remain symptom free after 5 years versus 79% of the patients without previous bypass grafting (p less than 0.001). Long-term success rates for native vessel angioplasty as compared with bypass graft angioplasty are similar. Patients with a short interval between the recurrence of angina after bypass grafting and the angioplasty attempt have a better chance of long-term success. Repeat angiography indicates that a restenosis occurs after angioplasty of a venous graft in 31% and in the native system in 28.6% and that signs of progression of coronary artery disease elsewhere are present in 30%. Of the 83 patients, 11 had reoperation eventually. We conclude that percutaneous transluminal coronary angioplasty after coronary bypass grafting gives less satisfactory results than a primary procedure, that angioplasty provides symptomatic relief in a smaller number of patients than in those with primary angioplasty, but that symptomatic relief is often sufficient to further postpone or prevent bypass grafting and can be achieved with low mortality and low complication rates.

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