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Short and long-term outcomes of percutaneous revascularization in patients with prior coronary artery bypass graft
F D'Ascenzo1, A Gonella, G Longo
1Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy.
Insights
Percutaneous coronary intervention (PCI) in native vessels is a viable option for patients with prior coronary artery bypass grafting (CABG), even with treatable bypass graft disease. This approach shows comparable long-term outcomes to treating the bypass grafts directly.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Patients with prior coronary artery bypass grafting (CABG) frequently require percutaneous coronary intervention (PCI).
- Optimal PCI strategy (native vessels vs. bypass grafts) remains unclear, impacting risk-benefit assessment.
Purpose of the Study:
- To compare long-term clinical outcomes of PCI in native coronary vessels versus bypass grafts in patients with prior CABG.
- To evaluate the safety and efficacy of treating native vessels despite the presence of potentially treatable saphenous vein graft (SVG) disease.
Main Methods:
- Retrospective analysis of 109 patients with prior CABG undergoing PCI (July 2002-June 2004).
- Patients categorized into three groups: SVG PCI, optional native vessel PCI, and mandatory native vessel PCI.
- Primary endpoint: long-term major adverse clinical events (MACE), including death, myocardial infarction, and target vessel revascularization (TVR).
Main Results:
- No significant difference in early or long-term MACE rates among the three groups (SVG, optional native, mandatory native).
- Long-term MACE occurred in 39.3% (SVG), 28% (optional native), and 39.4% (mandatory native).
- No significant differences observed in death or TVR rates between groups after over three years of follow-up.
Conclusions:
- PCI of native coronary vessels is a feasible strategy in selected patients with prior CABG.
- This approach can be considered even when saphenous vein graft lesions are present and potentially treatable.
- Outcomes suggest that prioritizing native vessel intervention does not necessarily lead to worse long-term results.
Aim:
Patients with prior coronary artery bypass grafting (CABG) represent a sizable portion of those undergoing percutaneous coronary intervention (PCI): in many instances, it is unclear whether performing PCI on the bypass graft or in the native coronary vessels can offer the best risk-benefit balance.
Methods:
We included patients with prior CABG undergoing PCI at our center between July 2002 and June 2004 and we distinguished them in three groups. Those in whom PCI was performed on stenotic saphenous vein graft (SVG group), those in whom PCI was performed on native vessels despite the presence of potentially treatable SVG disease (optional native group), and those in whom PCI had to be performed mandatorily in the native vessels because of chronic SVG occlusions or disease in non-bypassed segments (mandatory native group). The primary end-point was long-term rate of major adverse clinical events (MACE, i.e. death, myocardial infarction, or target vessel revascularization).
Results:
We identified 109 patients: 28 were in the SVG group, 25 in the optional native group, and 56 in the mandatory native group. Early major adverse cardiac events (MACE) occurred with similar frequency in the three groups (respectively, 9.1%, 0% and 5.7%, P=0.35). After more than three years of follow-up, MACE occurred in 39.3% vs. 28 and 39.4% (P=0.59), death occurred in 27.2 vs. 24.0% vs. 13.5% (P=0.30), and TVR in 27.3% vs. 8.0% vs. 28.8% (P=0.14).
Conclusion:
In selected patients, PCI of native coronary vessels despite the presence of apparently treatable SVG lesions can be envisioned.
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