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EMERGENT CORONARY ANGIOGRAM FOR GRAFT FAILURE SUSPICION AFTER CORONARY ARTERY BYPASS GRAFTING: THE MONTREAL HEART INSTITUTE EXPERIENCE Gilbert Gosselin, MD Between September 2000 and August 2008, we identified 58 consecutive patients who underwent a coronary angiogram following CABG during the same hospital admission for suspected myocardial ischemia. Patients were divided in 2 groups: conservative treatment (group 1) and revascularization (group 2). We reviewed the medical records <strong>of</strong> all 58 patients as well as the pre-operative and post-CABG angiographies. Results Among a total <strong>of</strong> 158 inserted grafts, 50 (32%) were identified as failing ones. <strong>The</strong> most common cause <strong>of</strong> graft failure was graft occlusion or subtotal (> 70%) anastomotic stenosis (n=35), followed by graft kinking (n=11). Diffuse post-operative graft vasospasm was found in 4 patients. Conservative treatment was decided for 23 patients (39.7%) and percutaneous revascularization was the treatment in 35 patients (60.3%) . When conservative treatment was decided, the left internal mammary artery (LIMA) graft was functional in all cases. Revascularizations were performed on the native coronary arteries in 26 cases (74.3%). In 31.4% (31 pts), the revascularization was realized in or through the graft. One intervention was complicated by anastomosis rupture during stent implantation. <strong>The</strong> 30-day mortality was 19% (11 pts) in the whole cohort and reached 29% in the revascularization group (10 pts). Conclusions Overtime rescue PCI following failed CABG was increasingly used in our institution. Anastomotic lesions should be considered with caution considering the risk <strong>of</strong> rupture. OPTIMAL ANTIPLATELETS THERAPY IN ACUTE CORONARY SYNDROME BEFORE INTERVENTION Gilbert Gosselin, MD ASA has been used as a standard therapy for ACS along with heparin following the paper <strong>of</strong> Dr Théroux in the New England Journal <strong>of</strong> Medicine in 1992. With the use <strong>of</strong> PCI and stents in ACS patients, the use <strong>of</strong> thiopyridines was established, first with ticlopidine and more recently with clopidogrel. In spite <strong>of</strong> many in vitro trials, the optimal dose <strong>of</strong> clopidogrel as well as ASA is not established in ACS patients undergoing intervention. <strong>The</strong> results <strong>of</strong> the CURRENT trial will give us an answer to these questions. More recent drugs (prazugrel…) will soon be widely available and be part <strong>of</strong> our optimal medical treatment. 91
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