RESPONSIBLE FACTORS EFFECTING THE COURSE TO ELECTIVE CORONARY ARTERY SURGERY IN THE FOLLOW-UP AFTER PTCA

Mehmet Ali Özatik^{Mehmet Kamil Göl}, Mustafa Soylu^*, Şule Korkmaz^{Süha Küçükaksu}

Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara
^*Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Ankara

Background: Restenosis can develop after percutaneous transluminal coronary angioplasty (PTCA), which is one of the treatment modalities of coronary artery disease, and some of these patients need coronary artery bypass grafting (CABG) surgery as the second intervention. In this study, we tried to evaluate the reasons for CABG in patients who underwent elective coronary artery bypass due to restenosis after PTCA.

Methods: Between January 1995-December 2000, PTCA was performed in 2990 patients in cardiology clinic. Of these, 102 patients (3.4%) have undergone CABG after a mean of 22.6 months (1-68 months) due to restenosis and/or new lesions developed in coronary arteries. The risk factors of this group were compared with a control group, which included randomly chosen 100 patients who have undergone PTCA in the same period, but didnt need a secondary revascularization procedure. A scoring was applied to the lesions of the patients according to localization, type and the degree of stenosis. Results: In the study group, PTCA was applied to left anterior descending artery in 34.3% (n = 35), to circumflex system in 39.5% (n = 40) and to right coronary artery in 37% (n = 38) of patients. Type A lesion was present in 25.2%, Type B lesion in 68.9% and Type C lesion in 6.2% of the vessels on which PTCA was performed. Univariate analysis revealed that mean age of the study group was lower (p = 0.011), presence of unstable angina (p = 0.024), continuation of smoking (p = 0.032), and absence of previous myocardial infarction history (p < 0.001) were found to be significantly higher in the study group. Scoring of the lesions revealed that, if PTCA applied to higher stenosis, better outcomes are achieved and score for the localization of the lesion was higher in the study group (p = 0.029).

Conclusion: Coronary artery bypass surgery might be needed due to restenosis after PTCA applications. Patient and lesion specific factors are effective for this outcome. The preference and the characteristics of the patient should be taken into consideration when deciding for the best therapeutic approach.

Keywords : Percutaneous transluminal coronary angioplasty, restenosis, coronary artery bypass surgery

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