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The IX t h Makassed Medical Congress - American University of Beirut

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EMERGENT CORONARY ANGIOGRAM FOR GRAFT FAILURE SUSPICION AFTER<br />

CORONARY ARTERY BYPASS GRAFTING:<br />

THE MONTREAL HEART INSTITUTE EXPERIENCE<br />

Gilbert Gosselin, MD<br />

Between September 2000 and August 2008, we identified 58 consecutive patients who underwent<br />

a coronary angiogram following CABG during the same hospital admission for suspected<br />

myocardial ischemia. Patients were divided in 2 groups: conservative treatment (group 1) and<br />

revascularization (group 2). We reviewed the medical records <strong>of</strong> all 58 patients as well as the<br />

pre-operative and post-CABG angiographies.<br />

Results<br />

Among a total <strong>of</strong> 158 inserted grafts, 50 (32%) were identified as failing ones. <strong>The</strong> most common<br />

cause <strong>of</strong> graft failure was graft occlusion or subtotal (> 70%) anastomotic stenosis (n=35), followed by<br />

graft kinking (n=11). Diffuse post-operative graft vasospasm was found in 4 patients. Conservative<br />

treatment was decided for 23 patients (39.7%) and percutaneous revascularization was the<br />

treatment in 35 patients (60.3%) . When conservative treatment was decided, the left internal<br />

mammary artery (LIMA) graft was functional in all cases. Revascularizations were performed<br />

on the native coronary arteries in 26 cases (74.3%). In 31.4% (31 pts), the revascularization was<br />

realized in or through the graft.<br />

One intervention was complicated by anastomosis rupture during stent implantation. <strong>The</strong> 30-day<br />

mortality was 19% (11 pts) in the whole cohort and reached 29% in the revascularization group<br />

(10 pts).<br />

Conclusions<br />

Overtime rescue PCI following failed CABG was increasingly used in our institution. Anastomotic<br />

lesions should be considered with caution considering the risk <strong>of</strong> rupture.<br />

OPTIMAL ANTIPLATELETS THERAPY IN ACUTE CORONARY SYNDROME<br />

BEFORE INTERVENTION<br />

Gilbert Gosselin, MD<br />

ASA has been used as a standard therapy for ACS along with heparin following the paper <strong>of</strong> Dr<br />

Théroux in the New England Journal <strong>of</strong> Medicine in 1992.<br />

With the use <strong>of</strong> PCI and stents in ACS patients, the use <strong>of</strong> thiopyridines was established, first with<br />

ticlopidine and more recently with clopidogrel. In spite <strong>of</strong> many in vitro trials, the optimal dose <strong>of</strong><br />

clopidogrel as well as ASA is not established in ACS patients undergoing intervention. <strong>The</strong> results<br />

<strong>of</strong> the CURRENT trial will give us an answer to these questions. More recent drugs (prazugrel…) will<br />

soon be widely available and be part <strong>of</strong> our optimal medical treatment.<br />

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