Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery.
J Am Coll Cardiol
; 73(18): 2299-2306, 2019 05 14.
Article
em En
| MEDLINE
| ID: mdl-31072574
ABSTRACT
BACKGROUND:
Few studies have evaluated the effect of chronic calcium-channel blocker therapy (CCB) on the angiographic and clinical outcome of radial artery (RA) grafts used for coronary bypass surgery.OBJECTIVES:
The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts.METHODS:
Patient-level data of 6 angiographic randomized trials evaluating RA graft status at midterm follow-up were joined in this observational analysis. Cox regression and propensity score methods were used to evaluate the effect of CCB on the incidence of a composite of major adverse cardiac events (MACE) (death, myocardial infarction, and repeat revascularization) and graft occlusion.RESULTS:
The study population included 732 patients (502 on CCB). The median clinical follow-up was 60 months. The cumulative incidence of MACE at 36, 72, and 108 months was 3.7% vs. 9.3%, 13.4% vs. 17.6%, and 16.8% vs. 20.5% in the CCB and no CCB groups, respectively (log-rank p = 0.003). Protocol-driven angiographic follow-up was available in 243 patients in the CCB group and 200 in the no CCB group. The median angiographic follow-up was 55 months. The cumulative incidence of RA occlusion at 36, 72, and 108 months was 0.9% vs. 8.6%, 9.6% vs. 21.4%, and 14.3% vs. 38.9% in the CCB and no CCB groups, respectively (log-rank p < 0.001). After controlling for known confounding, CCB therapy was found to be consistently associated with a significantly lower risk of MACE (multivariate Cox hazard ratio 0.52; 95% confidence interval 0.31 to 0.89; p = 0.02) and RA graft occlusion (multivariate Cox hazard ratio 0.20; 95% confidence interval 0.08 to 0.49; p < 0.001).CONCLUSIONS:
In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
/
Bloqueadores dos Canais de Cálcio
/
Ponte de Artéria Coronária
/
Artéria Radial
/
Oclusão de Enxerto Vascular
/
Infarto do Miocárdio
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article