Outcomes After Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Grafting

Abstract

In patients with previous coronary artery bypass graft surgery (CABG) requiring subsequent percutaneous coronary intervention (PCI), there is uncertainty whether bypass grafts or native coronary arteries should be targeted. We analyzed data from 2,764 patients with previous CABG in the Melbourne Interventional Group registry (2005 to 2018), divided into 2 groups: those who underwent PCI in a native vessel (n = 1,928) and those with PCI in a graft vessel (n = 836). Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (previous myocardial infarction, heart failure, ejection fraction <50%, renal impairment, peripheral and cerebrovascular disease), and had high-risk procedural features (American College of Cardiology and American Heart Association types B2/C lesions). However, patients in the native vessel group were more likely to have PCI in chronic total occlusions. The majority of graft PCI were in saphenous vein grafts (84%), with 10% to radial and 6% in 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 = 0.02), and inpatient stent thrombosis (p = 0.03). However, the 30-day mortality and major adverse cardiovascular and cerebrovascular events were similar. The unadjusted long-term mortality (median follow-up of 4.8 years) was higher in patients who underwent a graft PCI (44 vs 32%, p <0.001); however, after Cox proportional hazards modeling, PCI vessel type was not a predictor of long-term mortality (hazard ratio 1.13, 95% confidence interval 0.96 to 1.33, p = 0.14). In conclusion, early clinical outcomes and risk-adjusted long-term mortality are similar for patients with previous CABG who underwent PCI in a native vessel or a bypass graft.