The influence of residual disease after coronary bypass on the 5-year survival rate of 1274 men with coronary artery disease.

Abstract

SUMMARY To determine the independent influence of the extent and site of residual disease on late survival, we analyzed the fate of 1448 consecutive patients who had coronary artery bypass surgery during [1968][1969][1970][1971][1972][1973][1974] residual disease itself is an important independent variable affecting survival and, if so, to determine the influence on survival of the varying extent and site of residual disease.Materials and Methods A residual lesion was defined as the presence of a luminal stenosis causing more than a 70% reduction in diameter in a major coronary artery without a bypass graft attached distal to it. For example, a patient with two-vessel disease who had received two grafts was classified as having no residual disease, whereas if only one graft had been placed, one residual lesion was considered present. Thus, residual disease could consist either of small or diffusely diseased vessels that were inoperable or of vessels of good size, suitable for grafting, that were not operated upon. Because all of the patients in this study were referred, evaluated and operated upon by one cardiology group and surgeon in the same institution using constant surgical techniques, the prevalence of truly ungraftable vessels was assumed to be constant throughout the period of this study. All

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

“…Regarding the clinical relevance of angiographic CR, previous studies have shown conflicting results. Some reports in the pre‐DES era showed the clear benefit of angiographic CR rather than IR, and adverse clinical events related to the residual disease after PCI 3, 4, 5, 6, 7, 8. However, other studies reported unclear benefit of angiographic CR over IR 15, 16, 17.…”

“…Although previous studies suggested that angiographic complete revascularization (CR) was more advantageous than incomplete revascularization (IR) and residual disease was associated with adverse clinical outcome after PCI,3, 4, 5, 6, 7, 8 the evidence regarding the benefit of angiographic CR over IR has been limited in CKD patients with multivessel CAD. Given the increasing prevalence of CKD, it would be an important issue to clarify the safety and efficacy of angiographic CR in this high‐risk population 1, 9.…”

Early and mid-term results of coronary endarterectomy: Influence of cardiopulmonary bypass and surgical techniques

“…It has been shown that incomplete revascularization is one of the most important risk factors associated with poor ventricular function, high reoperation rate, perioperative morbidity, and mortality [8,9]. However, with advances in PCI, the lesions of coronary arteries treated surgically have become more calcified and complex; as such, it would be difficult to achieve complete revascularization using the conventional CABG in numerous cases with diffuse CAD.…”

Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

“…The concept of complete myocardial revascularization gained strength in cardiology because of the higher incidence of late deaths, recurrence of angina, myocardial infarction, and reoperations in patients treated incompletely 5,6 . Improvement in the results of myocardial revascularization caused by a larger experience, by the development of methods of myocardial protection, and by the use of the internal thoracic artery has allowed its application in patients Data between parentheses are percentages; * -statistically significant data; ** -three or more risk factors for coronary heart disease; AMIacute myocardial infarction; MR-myocardial revascularization; LM left main disease; EF-ejection fraction.…”