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Article Type

Original Study

Abstract

Objective The aim of this work was to study the management of coronary insufficiency in patients with prior coronary artery bypass grafting (CABG) either by medical treatment, by redo-CABG or by percutaneous coronary intervention (PCI). Background Coronary insufficiency after CABG is a problem, and there are three different strategies for its management: medical treatment, redo-CABG, and PCI. Patients and methods This is a prospective nonrandomized study conducted at ASSALAM International Hospital on 62 patients with prior CABG who were referred for coronary angiography for the evaluation of chest pain and were followed for 1 year to assess the occurrence of major adverse cardiac event and recurrent chest pain after a physician-directed management choice. Results Of the patients included, 15 (24.2%) were advised for intensification of medical treatment, six (9.7%) were referred for redo-CABG, whereas 41 (66.1%) patients underwent PCI. Management of post-CABG coronary insufficiency depends on several factors including the date since CABG, the extent of native coronary artery disease, the percentage of venous graft diseased, and the presence of diseased left internal mammary artery supplying LAD. There was no significant difference in the outcome with regard to recurrent chest pain or major adverse cardiac event between these groups. However, procedural success was significantly higher in PCI to native coronary arteries (96.8%) than in PCI to saphenous vein graft (70%). Conclusion In patients with coronary insufficiency after CABG, there was no significant difference in the patient outcome between different management strategies including medical treatment, redo-CABG or PCI.

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