Long-term angiographic results of coronary endarterectomy

Background. To evaluate the long-term patency of endarterectomized coronary vessels, we studied patients having recatheterization after coronary arter y bypass grafting. Methods. Forty-one clinical and angiographic variables were analyzed in 97 study patients who had coronary endarterectomy (CE) and in 154 control pati ents who did not have CE but who had repeat catheterization after coronary artery bypass grafting. Results. Ninety-seven patients had 132 CEs. The right coronary artery was t he most commonly endarterectomized vessel (73 of the 132 endarterectomized Vessels). At a mean of 7.1 years of follow-up, significantly fewer bypass g rafts to endarterectomized vessels were patent compared with nonendarterect omized vessels (40% of endarterectomized Vessels compared with 58% of nonen darterectomized vessels in study patients and 65% in control patients, p = 0.0003). The only predictor of long-term CE graft patency is age-adjusted b ody surface area (p = 0.0068). Patency in grafts to nonendarterectomized ve ssels is diminished by hypertension (p = 0.046) and current cigarette use ( p = 0.024) and improved by use of mammary artery grafting (p < 0.0001). Conclusions. These results show that long-term patency in bypass grafts to endarterectomized Vessels is less common than in nonendarterectomized vesse ls and that this patency is related to larger body size. Patency in nonenda rterectomized vessels is reduced by risks of arteriosclerosis. This suggest s that CE should be used with caution in smaller patients and that aggressi ve control of risk factors for atherogenesis is particularly important in p atients who have CE. On the basis of these results, we speculate that the e xtent of disease is advanced in patients who require CE. (C) 2000 by The So ciety of Thoracic Surgeons.