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Coronary Artery Disease In Microvascular Breast Reconstruction: Impact Of Recipient Vessel Selection On Coronary Artery Disease Intervention Rates
Brigit D. Baglien, M.D., Nathaniel J. Parchment, MD, Michael Saunders, MD, PhD, Danika Meldrum, BS, Eric P. Cantey, MD, MSc, William P. Truesdell, MD, Barbara CS Hamilton, MD, Robert B. Hawkins, MD, MSc, Paige L. Myers, MD, Adeyiza O. Momoh, MD.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: The impact of internal mammary artery (IMA) ligation in microsurgical breast reconstruction on future coronary intervention is currently unknown. This study aims to evaluate coronary artery disease (CAD) prevalence and intervention rates in microsurgical breast reconstruction recipients to elucidate the impact of IMA unavailability.
METHODS: A retrospective cohort study was conducted utilizing the Pearl Diver Mariner claims database. Microsurgical breast reconstruction patients with CAD were identified and propensity score matched 1:10 to non-reconstruction, female patients with CAD. The primary outcome was CAD intervention rate, coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). Subsequently, a single-center, retrospective study evaluating CAD characteristics for all microsurgical breast reconstruction recipients (2014 - 2019) was performed.
RESULTS: Of 33,792 women who underwent microsurgical breast reconstruction, 13.2% developed CAD. Within the matched cohort of 22,890 women, women with CAD after reconstruction had fewer CAD interventions (4.1% vs 6.0%; p<0.001), though rate of CABG for patients receiving CAD interventions did not differ (23.3% vs 25.9%; p = 0.62). The single-center data included 301 patients. Four women (1.3%) were diagnosed with CAD preoperatively, two requiring preoperative PCI, and 7 patients (2.3%) developed CAD within 5 years postoperatively. No CAD interventions were recorded.
CONCLUSION: This study demonstrates CAD is common among women undergoing microsurgical breast reconstruction, with lower intervention rates compared with non-reconstruction patients, underscoring the need for improved guidelines and interdisciplinary collaboration.
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