RT Journal Article
T1 Internal mammary artery graft failure: Clinical features, management, and long-term outcomes
A1 Núñez-Gil, Iván J.
A1 Alfonso, Emilio
A1 Salinas, Pablo
A1 Nombela-Franco, Luis
A1 Ramakrishna, Harish
A1 Jimenez-Quevedo, Pilar
A1 Gonzalo, Nieves
A1 Feltes, Gisela
A1 Escaned Barbosa, Javier
A1 De Agustín Loeches, José Alberto
A1 Vivas Balcones, Luis David
A1 Macaya Miguel, Carlos
A1 Fernández Ortiz, Antonio Ignacio
AB Objective: Data on long-term outcomes after internal mammary artery (IMA) coronary graft failure are scarce. Our objective was to describe the clinical characteristics, management, and prognosis after angiographically confirmed IMA graft failure following coronary revascularization.Methods: A three-hospital retrospective registry, observational and descriptive, with prospective followup of all consecutive cases of IMA graft failure between 2004 and 2014 was conducted. After treatment, clinical and procedural features were compared between those with and without cardiovascular events.Results: Fifty-seven patients were included (89% male, mean age: 62 years, at surgery) in the registry.Most patients underwent an IMA angioplasty (percutaneous coronary intervention [PCI], 74%). In nine cases, the PCI failed at the graft level, and seven underwent a native vessel revascularization. Native vessel treatment was performed in 20% of the study subjects, all with stents. Finally, medical management was decided in three cases. Events after treatment for IMA graft failure were frequent (50.8%), during a median follow-up of 7.5 years. Acute presentation (hazard ratioMACE ¼ 1.35; 95% confidence interval (CI): 1.12e3.00, p < 0.01), age of the patient (hazard ratioMACE ¼ 1.85, 95% CI: 1.17e2.11, p < 0.01), presence of diabetes mellitus (hazard ratioMACE ¼ 2.75, 95% CI: 1.13e6.69, p ¼ 0.02), and the management modality used (IMA-simple angioplasty VS IMA-stenting: hazard ratioMACE ¼ 5.5, 95% CI: 1.40e21.15,p ¼ 0.01) displayed prognostic relevance on multivariate analysis. All-cause mortality occurred in 21.1%and presentation as infarction (hazard ratioDEATH ¼ 1.05, 95% CI: 1.01e2.17, p ¼ 0.01), age (hazardratioDEATH ¼ 9.08, 95% CI: 2.52e32.69, p < 0.01), and left ventricular ejection fraction (hazardratioDEATH ¼ 3.68, 95% CI: 1.65e8.18, p < 0.01) were independent predictors of the same.Conclusions: In this long-term registry, most patients presented with an acute condition (myocardialinfarction, progressive angina) within 12 months after surgery. Acute presentation, age, diabetes mellitus, reduced left ventricular ejection fraction, IMA graft failure segment affected, and the managementstrategy were related with long-term prognosis.
PB Elsevier
YR 2018
FD 2018-09-01
LK https://hdl.handle.net/20.500.14352/131054
UL https://hdl.handle.net/20.500.14352/131054
LA eng
NO Núñez-Gil IJ, Alfonso E, Salinas P, Nombela-Franco L, Ramakrishna H, Jimenez-Quevedo P, Escaned J, Gonzalo N, de Agustin JA, Vivas D, Feltes G, Macaya C, Fernández-Ortiz A. Internal mammary artery graft failure: Clinical features, management, and long-term outcomes. Indian Heart J. 2018 Dec;70 Suppl 3(Suppl 3):S329-S337. doi: 10.1016/j.ihj.2018.08.016. Epub 2018 Sep 1. PMID: 30595285; PMCID: PMC6309709.
DS Docta Complutense
RD 19 jun 2026