Outcomes after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafts (CABG).

Abstract

Background: PCI is the most common revascularisation strategy in patients with prior CABG. However, there are limited Australian data on the outcomes of PCI in this cohort.

Aims and Methods: We determined the patterns of PCI in patients with prior CABG, identifying factors associated with PCI in native coronaries versus bypass grafts, and examined their in-hospital, 30-day and 12-month clinical outcomes using the Melbourne Interventional Group registry.

Results: 490 patients with prior CABG underwent graft PCI (GPCI) compared to 969 in their native coronary artery (NPCI). Patients undergoing GPCI were older and had more days since their CABG surgery. More patients had acute coronary syndrome or urgent/rescue PCI in the graft group. There were higher rates of IIb/IIIa inhibitors, LMWH and distal embolic device use in GPCI. In addition, graft lesions were more complex and longer stents were deployed. However, more chronic total occlusions were treated in the NPCI group. Although lesion success rates were higher, GPCI resulted in more perforations, transient or persistent no reflow and early stent thrombosis. There was no difference in outcomes in-hospital or at 30 days. Although 12-month hospital readmission (47.03% GPCI vs 40.76% NPCI, p = 0.025) and MACE (22.24% GPCI vs 17.44% NPCI, p = 0.027) was higher in the GPCI group on univariate analysis, there was no statistical difference on multivariate analysis (OR 1.25, p = 0.127).

Conclusions: In patients with previous CABG undergoing PCI, we observed differences in clinical and procedural characteristics between the GPCI and NPCI groups, but found no significant differences in medium-term outcomes.