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Feasibility of percutaneous coronary interventions in early postcoronary artery bypass graft occlusion or stenosis
Ameen Abdulmalik1, Abdulrahman Arabi, Abdulwahhab Alroaini
1Department of Cardiology, St. John Hospital & Medical Center, Detroit, Michigan 48236, USA. ameen.abdulmalik@stjohn.org
Insights
Percutaneous coronary intervention (PCI) for early graft occlusion after coronary artery bypass grafting (CABG) is feasible in over half of cases. This approach demonstrated a 14% restenosis rate at one year, with fewer readmissions for ischemia compared to no PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) patients often have complex anatomy unsuitable for percutaneous coronary intervention (PCI).
- These patients face increased risk of early graft occlusion, with limited data on PCI feasibility for this complication.
Purpose of the Study:
- To evaluate the feasibility and outcomes of PCI in treating early graft occlusion following CABG.
- To compare PCI outcomes with non-PCI management in this high-risk patient group.
Main Methods:
- Retrospective chart review of 46 patients with recurrent ischemia within three months post-CABG.
- Analysis included graft occlusion/stenosis, PCI success rates, and one-year follow-up for ischemia readmission and restenosis.
Main Results:
- Of 156 grafts, 63 were occluded/stenosed; 27 (43%) were not amenable to PCI.
- Successful PCI was performed on 34 grafts (54%) in 23 patients, with no deaths.
- At one year, 14% of PCI-treated vessels restenosed; 6 of 23 patients were readmitted with ischemia.
- In the no-PCI group, 11 of 23 patients were readmitted with ischemia, including one death.
Conclusions:
- PCI is a safe and feasible option for treating early post-CABG graft occlusion in selected patients.
- PCI success rates were comparable for native vessels and occluded grafts.
- The one-year target vessel restenosis rate after successful PCI was 14%, with favorable clinical outcomes compared to non-PCI management.
Background:
With continuing technical advances in percutaneous coronary interventions (PCI) for coronary artery disease (CAD), patients undergoing coronary artery bypass surgery (CABG) often have complex coronary anatomy that is not ideal for PCI. Because of the complex anatomy, these patients have a higher risk of early graft occlusion. The feasibility of PCI in the treatment of early graft occlusion is not well established.
Methods:
A retrospective chart review was performed of patients presenting with recurrent ischemia within three months post-CABG and at one-year follow-up.
Results:
Forty-six patients with 156 grafts were identified. Three presented with STEMI, 21 with NSTEMI, 21 with unstable angina, and one with congestive heart failure. Sixty-three grafts were occluded or stenosed (>70%). Twenty-seven grafts (43%) in 17 patients were not amenable to PCI. The other 34 grafts (54%) in 23 patients underwent successful PCI. PCI was performed upon native vessels and occluded grafts with equal frequency. Six patients had patent grafts. At one-year follow-up, six of 23 patients in the PCI group were readmitted with ischemia; five vessels (14%) in four patients had restenosed. There were no deaths. In the group with no PCI, 11 of 23 patients were readmitted with ischemia with one death.
Conclusion:
PCI for early post-CABG occlusion was safely performed in slightly more than half of target vessels. PCI was performed upon native vessels and occluded grafts with equal frequency. After initial PCI success, the clinical target vessel restenosis rate was 14% at one-year follow-up.
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