Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS)

Alderman, Edwin L.; Corley, Scott; Fisher, Lloyd D.; Chaitman, Bernard R.; Faxon, David P.; Foster, Eric D.; Killip, Thomas; Sosa, Julio A.; Bourassa, Martial G.

doi:10.1016/0735-1097(93)90429-5

Cited by 316 publications

(176 citation statements)

References 17 publications

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“…These include a higher rate of native vessel disease progression in diabetes, 13 the impact of diabetes on endothelial function particularly in the coronary microvasculature, 16 diabetes-associated hypercoagulability, 17 and an independent myocardial factor. 18,19 However, we believe that a more likely explanation is the differential risk of death from noncardiac causes.…”

Section: Discussionmentioning

confidence: 99%

“…Over the 44 years since the first coronary bypass operation, there have been several angiographic follow-up studies, but this is the first report with the primary objective of comparing graft patency in patients with and without diabetes. The Coronary Artery Surgery Study included an angiographic follow-up substudy, 13 but this analysis dealt primarily with the status of the native vessels (grafted and ungrafted) at 5 years after surgery. Graft status was not commented on.…”

Section: Discussionmentioning

confidence: 99%

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Coronary Bypass Graft Patency in Patients With Diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

et al. 2002

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Background-Few studies have compared long-term status of bypass grafts between patients with and without diabetes, and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG. Methods and Results-Among 1526 patients in BARI who underwent CABG as initial revascularization, 99 of 292 (34%) with treated diabetes mellitus (TDM) (those on insulin or oral hypoglycemic agents) and 469 of 1234 (38%) without TDM had follow-up angiography. Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention (mean 3.9 years) were reviewed. An average of 3.0 grafts were placed at initial CABG for patients with TDM (nϭ297; internal mammary artery [IMA], 33%) and 2.9 grafts for patients without TDM (nϭ1347; IMA, 34%). Patients with TDM were more likely than those without to have small (Ͻ1.5 mm) grafted distal vessels (29% versus 22%) and vessels of poor quality (9% versus 6%). On follow-up angiography, 89% of IMA grafts were free of stenoses Ն50% among patients with TDM versus 85% among patients without TDM (Pϭ0.23). For vein grafts, the corresponding percentages were 71% versus 75% (Pϭ0.40). After statistical adjustment, TDM was unrelated to having a graft stenosis Ն50% (adjusted odds ratio, 0.87; 95% CI, 0.58 to 1.32). Conclusions-Despite diabetic patients' having smaller distal vessels and vessels judged to be of poorer quality, diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up. Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coronary Bypass Graft Patency in Patients With Diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

et al. 2002

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“…Progression of nonbypassed segments was 18.6% at 5 years. 22 More recently, in a study of patients awaiting first PCI after diagnostic angiography, Kaski et al 23 found angiographic progression in 24% of patients at a median follow-up of 8 months and a 57% incidence of acute coronary events in those patients with lesion progression. Of those patients with stenoses Ͼ50%, culprit lesions progressed to a greater extent (28% of culprit lesions intended for angioplasty progressed) than did nonculprit lesions (9% progressed).…”

Section: Glaser Et Al Clinical Progression Of Incidental Lesionsmentioning

confidence: 99%

Clinical Progression of Incidental, Asymptomatic Lesions Discovered During Culprit Vessel Coronary Intervention

et al. 2005

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Background-With the reduction in restenosis rates by drug-eluting stents, there is new controversy concerning the optimal management of incidental, nontarget lesions identified during percutaneous coronary intervention (PCI). Such lesions have been treated conservatively because of risk of restenosis but now are being considered for PCI to prevent plaque instability. However, the impact of incidental stenoses on future cardiac events remains unknown. Methods and Results-We performed a retrospective cohort study to determine the rate and features of clinical plaque progression using the National Heart, Lung,

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“…Так, по данным исследо-вания CASS, процент стенозирования артерии больше 70% говорит о значимости поражения коронарной ар-терии и необходимости ее реваскуляризации [12]. Veterans Administration (США) и Европейские иссле-довательские центры принимают гемодинамически значимым стенозирование коронарной артерии свы-ше 50% [13].…”

Section: стресс-эхокг в оценке коронарного русла при ибсunclassified

Current Approaches to Evaluation of the Multivessel Coronary Atherosclerosis in Patients With Chronic Ischemic Heart Disease

Perutsky¹,

Коваленко²,

Константинов³

et al. 2011

Racionalʹnaâ farmakoterapiâ v kardiologii

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Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS)

Abstract: Univariate and multivariate associations with lesion progression and occlusion included diabetes, lesion location, elevated cholesterol level, interval infarction and lesion morphology. These angiographic results, collected in a prospective trial, are consistent with known risk factors.

Cited by 316 publications

References 17 publications

Coronary Bypass Graft Patency in Patients With Diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

Coronary Bypass Graft Patency in Patients With Diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

Clinical Progression of Incidental, Asymptomatic Lesions Discovered During Culprit Vessel Coronary Intervention

Current Approaches to Evaluation of the Multivessel Coronary Atherosclerosis in Patients With Chronic Ischemic Heart Disease

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