Percutaneous coronary interventions in patients with prior coronary artery bypass surgery: changes in patient
V Mathew1, A L Clavell, R J Lennon
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Percutaneous coronary intervention after coronary artery bypass graft (CABG) surgery shows improved success rates and long-term survival over 20 years. Despite sicker patients, advancements in techniques and stenting have reduced adverse cardiac events and repeat procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Patients with recurrent myocardial ischemia post-coronary artery bypass graft (CABG) surgery often require percutaneous coronary interventions (PCIs).
- Assessing trends in patient characteristics and outcomes of PCI following CABG is crucial for clinical practice.
- A 20-year analysis provides valuable insights into the evolution of PCI in this complex patient group.
Purpose of the Study:
- To evaluate changes in demographic and clinical profiles of patients with prior CABG undergoing PCI.
- To assess trends in procedural success and long-term outcomes over a 20-year period.
- To identify factors influencing outcomes in patients receiving PCI after CABG.
Main Methods:
- Prospective data collection on patients undergoing PCI after CABG.
- Comparison of angiographic and procedural success rates across three distinct time periods (1979-1989, 1990-1994, 1995-1998).
- Analysis of long-term event-free survival, including mortality, repeat revascularization, and recurrent angina.
Main Results:
- The patient cohort undergoing PCI post-CABG became older and sicker over time, with higher rates of diabetes, hypertension, and hyperlipidemia.
- Angiographic and procedural success rates significantly improved from 78% to 91% between the first and last periods (P < 0.0001).
- Long-term mortality, repeat revascularization, and recurrent severe angina rates decreased in the most recent cohort.
Conclusions:
- Despite increasing patient risk, PCI success rates and long-term survival following CABG have improved significantly.
- Advancements in interventional techniques, increased use of intracoronary stents, and adjunctive medications likely contribute to better outcomes.
- PCI remains an effective revascularization strategy for patients with recurrent ischemia after CABG, with progressively better results over time.
Purpose:
Patients who develop recurrent myocardial ischemia after coronary artery bypass graft (CABG) surgery are often referred for percutaneous coronary interventions. The objective of this study was to evaluate the changing demographic and clinical characteristics, and procedural and long-term outcomes, in patients with prior CABG referred for percutaneous coronary interventions during a 20-year period.
Methods:
We prospectively collected data on patients who underwent coronary interventional procedures following CABG surgery. We compared angiographic and procedural success, and long-term event-free survival, among patients who had procedures from 1979 to 1989 (n = 393), from 1990 to 1994 (n = 811), and from 1995 to 1998 (n = 937).
Results:
Patients in the 1995 to 1998 cohort were older, had a lower mean left ventricular ejection fraction, and were more likely to have diabetes, hypertension, and hyperlipidemia, but less likely to smoke. They were more likely to have treatment of complex lesions, including vein graft lesions, and had more prior CABG surgeries. More patients received intracoronary stents in 1995 to 1998. Both angiographic success rates (78% from 1979 to 1989, 88% from 1990 to 1994, and 91% from 1995 to 1998, P < 0.0001) and procedural success rates (78%, 86%, and 91%, P < 0.0001) improved with time. Long-term mortality was greater in the pre-1990 group (relative risk = 1.8, 95% confidence interval: 1.3 to 2.4) and 1990 to 1994 group (relative risk = 1.7, 95% confidence interval: 1.3 to 2.2) compared with the 1995 to 1998 group, as were the likelihoods of repeat revascularization and recurrent severe angina.
Conclusion:
Although the demographic and clinical characteristics of patients who underwent percutaneous intervention following CABG surgery indicate that they are at increasingly greater risk of adverse cardiac events, success rates and long-term survival have improved with time. The rates of recurrent severe angina as well as of subsequent revascularization have also decreased, probably as a result of improvements in technique and greater use of stents and adjunctive medications.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Cardiac Catheterization IV: Nursing Management