TY - JOUR
T1 - Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting
T2 - Results from the East Denmark heart registry
AU - Joshi, Francis R
AU - Biasco, Luigi
AU - Pedersen, Frants
AU - Holmvang, Lene
AU - Helqvist, Steffen
AU - Tilsted, Hans-Henrik
AU - Abildgaard, Ulrik
AU - Kelbaek, Henning
AU - Lassen, Jens F
AU - Jørgensen, Erik
AU - De Backer, Ole
AU - Engstrøm, Thomas
N1 - © 2016 Wiley Periodicals, Inc.
PY - 2017/2/15
Y1 - 2017/2/15
N2 - Background: There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro-vascular coronary disease and it is not known how often targets for intervention are identified. Methods: Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014. Clinical and procedural data were prospectively stored in a regional electronic database. Follow-up data were available for all patients, by means of records linked to each Danish social security number. Results: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08–3.44], P = 0.027), significant angina (HR 1.49 [1.18–1.88], P = 0.006 for angina class ≥ II, and HR 2.04 [1.61–2.58], P < 0.001 for angina class ≥ III) and a positive pre-procedural stress test (HR 2.56 [1.42–4.60], P < 0.001) were independent predictors of revascularization. Stress testing was, however, used less frequently than in patients without prior CABG (17.2% vs. 24.2%, P < 0.001). The positive predictive values for subsequent revascularization were 47.8%, 51.4%, and 66.9% for exercise ECG, stress echocardiography, and myocardial perfusion scintigraphy (MPS), respectively. Conclusions: Invasive angiography leads to revascularization in a quarter of patients with angina and prior CABG; the threshold for referral may be too low. Non-invasive stress testing predicts the need for revascularization but appears underused and MPS, in particular, may better identify patients likely to require revascularization.
AB - Background: There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro-vascular coronary disease and it is not known how often targets for intervention are identified. Methods: Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014. Clinical and procedural data were prospectively stored in a regional electronic database. Follow-up data were available for all patients, by means of records linked to each Danish social security number. Results: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08–3.44], P = 0.027), significant angina (HR 1.49 [1.18–1.88], P = 0.006 for angina class ≥ II, and HR 2.04 [1.61–2.58], P < 0.001 for angina class ≥ III) and a positive pre-procedural stress test (HR 2.56 [1.42–4.60], P < 0.001) were independent predictors of revascularization. Stress testing was, however, used less frequently than in patients without prior CABG (17.2% vs. 24.2%, P < 0.001). The positive predictive values for subsequent revascularization were 47.8%, 51.4%, and 66.9% for exercise ECG, stress echocardiography, and myocardial perfusion scintigraphy (MPS), respectively. Conclusions: Invasive angiography leads to revascularization in a quarter of patients with angina and prior CABG; the threshold for referral may be too low. Non-invasive stress testing predicts the need for revascularization but appears underused and MPS, in particular, may better identify patients likely to require revascularization.
KW - Aged
KW - Angina, Stable/diagnostic imaging
KW - Coronary Angiography
KW - Coronary Artery Bypass/adverse effects
KW - Denmark
KW - Echocardiography, Stress
KW - Electrocardiography
KW - Exercise Test
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Perfusion Imaging
KW - Percutaneous Coronary Intervention
KW - Predictive Value of Tests
KW - Referral and Consultation
KW - Registries
KW - Retreatment
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1002/ccd.26598
DO - 10.1002/ccd.26598
M3 - Journal article
C2 - 27219901
SN - 1522-1946
VL - 89
SP - 341
EP - 349
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 3
ER -