Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery.

Aged Calcium Channel Blockers / therapeutic use Cohort Studies Coronary Angiography / methods Coronary Artery Bypass / adverse effects Coronary Artery Disease / drug therapy Female Graft Occlusion, Vascular / etiology Graft Survival / drug effects Humans Male Middle Aged Myocardial Infarction / etiology Radial Artery / diagnostic imaging Randomized Controlled Trials as Topic Reoperation / statistics & numerical data Transplants / diagnostic imaging Treatment Outcome

CABG calcium-channel blocker radial artery

Journal

Journal of the American College of Cardiology

ISSN: 1558-3597

Titre abrégé: J Am Coll Cardiol

Pays: United States

ID NLM: 8301365

Informations de publication

Date de publication:
14 05 2019

Historique:

received: 23 10 2018

revised: 25 01 2019

accepted: 07 02 2019

entrez: 11 5 2019

pubmed: 11 5 2019

medline: 3 3 2020

Statut: ppublish

Résumé

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. The purpose of this study was to evaluate if CCB influences midterm clinical and angiographic outcomes of RA grafts. 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. 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). In patients with RA grafts CCB is associated with significantly better midterm clinical and angiographic RA outcomes.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.jacc.2019.02.054 PMID: 31072574

pubmed: 31072574

pii: S0735-1097(19)34504-8

doi: 10.1016/j.jacc.2019.02.054

pii:

doi:

Substances chimiques

Calcium Channel Blockers 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

2299-2306

Subventions

Organisme : Department of Health

Pays : United Kingdom

Investigateurs

Mario Gaudino (M)

David P Taggart (DP)

Umberto Benedetto (U)

Brian Buxton (B)

Antonino Di Franco (A)

Stephen Fremes (S)

Leonard N Girardi (LN)

Steven Goldman (S)

David L Hare (DL)

William L Holman (WL)

Robert Habib (R)

Philip Hayward (P)

Jialin Mao (J)

Neil Moat (N)

Giuseppe Nasso (G)

Miodrag Peric (M)

Ivana Petrovic (I)

John D Puskas (JD)

Elfriede Ruttmann-Ulmer (E)

Thomas A Schwann (TA)

James Tatoulis (J)

Robert Tranbaugh (R)

Kyung Jong Yoo (KJ)

Commentaires et corrections

Type : CommentIn

Type : ErratumIn