Care of the Post-CABG Patient

An estimated 400,000 coronary artery bypass graft operations are performed annually in the United States. Saphenous vein grafts are the most commonly used conduits; however, graft failure is common. In contrast, left internal mammary artery grafts have more favorable long-term patency rates. Guidelines recommend aggressive secondary prevention. In the 2 decades following surgery, 16% of patients require repeat revascularization, and percutaneous coronary intervention accounts for 98% of procedures performed. Post-coronary artery bypass graft patients presenting with symptoms of acute coronary syndrome or progressive heart failure should undergo early coronary angiography given the high likelihood that such a presentation represents graft failure. Percutaneous coronary intervention in degenerated saphenous vein grafts is associated with embolization that may cause the “no-reflow phenomenon,” which can be avoided with the use of embolic protection devices. Hybrid revascularization procedures are a promising emerging strategy to avoid the placement of vein grafts.
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research

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This study aimed to evaluate current rates of ad hoc PCI use and associated risks of adverse outcomes in patients with stable coronary artery disease (CAD).MethodsWe identified 550,742 patients with stable CAD who underwent PCI in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from 2009–2017. We compared in-hospital bleeding, acute kidney injury (AKI), and mortality between patients receiving ad hoc vs. non-ad hoc PCI using logistic regression with inverse probability weighted propensity adjustment.ResultsBetween 2009 and 2017, 82.9% of patients underwent ad hoc PCI. Patients who did not undergo ad...
Source: American Heart Journal - Category: Cardiology Source Type: research
CONCLUSION: Women with STEMI are less likely to receive invasive management, revascularisation, or preventive medication at discharge. The reasons for these persistent differences in care require investigation. PMID: 30025513 [PubMed - as supplied by publisher]
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Conclusions ISCHEMIA will provide new scientific evidence regarding whether an invasive management strategy improves clinical outcomes when added to optimal medical therapy in patients with SIHD and moderate or severe ischemia.
Source: American Heart Journal - Category: Cardiology Source Type: research
Conclusion: Patients presenting with symptomatic HFrEF referred for cardiac catheterization have a high prevalence of obstructive CAD. Most patients with evidence of either surgical or non-surgical CAD during coronary angiography underwent revascularization, with PCI being the dominant revascularization method.
Source: Circulation: Cardiovascular Quality and Outcomes - Category: Cardiology Authors: Tags: Session Title: Poster Session PM Source Type: research
We examined characteristics and outcomes of 1598 CTO-PCIs performed from 2012-2017 at 12 high-volume centers. RESULTS: Patient age was 66 ± 10 years; 86% were men. An MCS device was used electively in 69 procedures (4%) and urgently in 22 procedures (1%). The most commonly used elective MCS device was Impella 2.5 or CP (62%). Compared to patients without elective MCS, patients with elective MCS had higher prevalence of prior heart failure (55% vs 29%; P
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
Authors: Kumar A, Wagener JF, Wojdyla D, Jones WS, Patel MR, Rao SV Abstract BACKGROUND: Studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with multivessel coronary artery disease (CAD) have shown lower repeat revascularization rates in patients who undergo CABG. The reason remains unclear. METHODS: We identified patients with multivessel CAD who received CABG or PCI enrolled in the Duke Databank for Cardiovascular Disease (2003 to 2012). We compared the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) between the t...
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Conclusion CLARIFY will provide a useful resource for understanding the current epidemiology of stable CAD.
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: TRIAL DESIGNS Source Type: research
Conclusion: In a representative assessment of coronary angiography and PCI outcomes, some major complications are higher that those reported in international literature. Significant access site bleeding was low, likely explained by the high prevalence of radial procedures. Future iterations of the patient information sheet and consent form may be improved by providing personalized risks.
Source: Circulation: Cardiovascular Quality and Outcomes - Category: Cardiology Authors: Tags: Session Title: Poster Session II Source Type: research
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