Long-term clinical outcome after percutaneous coronary intervention in grafts vs native vessels in patients with previous coronary artery bypass grafting

Can J Cardiol. 2011 Nov-Dec;27(6):716-24. doi: 10.1016/j.cjca.2011.08.115. Epub 2011 Oct 22.

Abstract

Background: The long-term clinical outcome of patients with previous coronary artery bypass grafting (CABG), undergoing percutaneous coronary intervention (PCI) is not clear.

Methods: Observational, retrospective study of post-CABG patients, who underwent PCI in either a graft or a native vessel.

Results: Out of 221 consecutive patients, those with PCI in both native vessel and graft (N=16) and missing follow-up data (N=15) were excluded. Out of the remaining 190 patients (age 67.9±9.6 years; 90.0% men), the graft-PCI group (N=88) had more occluded native vessels (2.1±0.8 vs 1.6±0.8; P<0.001), and fewer totally occluded grafts (0.55±0.6 vs 0.75±0.8; P=0.05) compared with the native vessel-PCI group (N=102). On follow-up (median duration 28 months), the incidence of major adverse cardiac events (MACEs), cardiac death, and repeat revascularization was higher in graft-PCI group compared with native vessel-PCI group (43.2% vs 19.6%, log-rank P<0.001; 19.3% vs 6.9%, log-rank P=0.008; and 23.9% vs 12.7%, log-rank P=0.02, respectively). Graft-PCI was independently associated with higher risk for major adverse cardiac events (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.45-5.57; P=0.002), cardiac death (HR, 3.44; 95% CI, 1.16-10.22; P=0.03) and repeat revascularization (HR, 2.41; 95% CI, 1.02-5.72; P=0.046).

Conclusions: Post-CABG patients, undergoing graft compared with native vessel-PCI, have worse long-term clinical outcome. Prospective studies are needed to elucidate the optimal revascularization strategy for such patients.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / methods*
  • Coronary Artery Bypass*
  • Coronary Restenosis / epidemiology
  • Coronary Restenosis / etiology
  • Coronary Restenosis / therapy*
  • Coronary Stenosis / surgery*
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular / complications
  • Graft Occlusion, Vascular / epidemiology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Incidence
  • Male
  • Prognosis
  • Retrospective Studies
  • Survival Rate / trends
  • Time Factors