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

Abstract

Background: In patients with prior coronary artery bypass grafting (CABG) requiring subsequent percutaneous coronary intervention (PCI) there is uncertainty about whether bypass grafts or native coronary arteries should be targeted. Methods: We analysed data from 2,764 patients with prior CABG in the Melbourne Interventional Group registry (2005–2018), divided into two groups: those undergoing PCI to a native vessel (n=1,928) and those with PCI to a graft vessel (n=836). Results: Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (prior myocardial infarction, heart failure, ejection fraction <50%, renal impairment, and peripheral and cerebrovascular disease), and high-risk procedural features (American College of Cardiology/American Heart Association types B2/C lesions). However, patients in the native vessel group were more likely to have PCI to a chronic total occlusion. The majority of graft PCI were to saphenous vein grafts (84%), with 10% to radial and 6% to left/right internal mammary artery grafts. Distal embolic protection devices were used in 30% of graft PCI. Patients with graft PCI had higher rates of no reflow (6.3% vs 1.5%; p<0.001), coronary perforation (p=0.016), and inpatient stent thrombosis (p=0.028). However, 30-day mortality and major adverse cardiovascular and cerebrovascular events were similar. Unadjusted long-term mortality (median follow-up 4.8 years) was higher in patients who had undergone a graft PCI (44% vs 32%; p<0.001), but following Cox proportional hazards modelling, PCI vessel type was not a predictor of long-term mortality (hazard ratio, 1.13; 95% confidence interval, 0.96–1.33 [p=0.14]). Conclusion: Early clinical outcomes and risk-adjusted long-term mortality are similar for patients with prior CABG undergoing PCI to a native vessel or a bypass graft.