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Percutaneous coronary intervention in patients with previous coronary artery bypass grafting (from the j-Cypher

Kyohei Yamaji1, Takeshi Kimura, Takeshi Morimoto

  • 1Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

The American Journal of Cardiology
|July 6, 2013
PubMed

Insights

Long-term outcomes of drug-eluting stent (DES) implantation after coronary artery bypass grafting (CABG) show similar mortality but increased revascularization risk. Saphenous vein graft intervention with DES worsened outcomes compared to native artery treatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Limited large-scale data exists on long-term percutaneous coronary intervention (PCI) outcomes post-coronary artery bypass grafting (CABG) in the drug-eluting stent (DES) era.
  • Patients with prior CABG undergoing PCI with DES represent a complex subgroup with potentially different risk profiles.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of PCI with DES in patients with and without a history of CABG.
  • To compare the risks of mortality, myocardial infarction, target lesion revascularization, and stent thrombosis between these groups.
  • To investigate outcomes specifically within the CABG subgroup, differentiating between saphenous vein graft (SVG) intervention and native coronary artery intervention.

Main Methods:

  • Analysis of the j-Cypher registry, including 12,812 patients who underwent sirolimus-eluting stent implantation.
  • Comparison of 5-year outcomes between 919 patients with prior CABG and those without.
  • Multivariable adjustment for confounders to assess adjusted risks.
  • Subgroup analysis within the prior CABG group based on whether SVG or native coronary artery was the target of PCI.

Main Results:

  • Crude 5-year mortality was higher in patients with prior CABG (19.9% vs 14.0%, p < 0.001).
  • After adjustment, mortality risk was similar (HR 0.99, p=0.90), but target lesion revascularization risk was higher in the prior CABG group (HR 1.25, p=0.01).
  • Among patients with prior CABG, SVG intervention with first-generation DES was associated with significantly higher adjusted risks of cardiac death, myocardial infarction, target lesion revascularization, and definite stent thrombosis compared to native artery intervention.

Conclusions:

  • Adjusted long-term mortality is similar for patients undergoing PCI with DES regardless of prior CABG status.
  • Patients with prior CABG have an increased risk of target lesion revascularization after PCI with DES.
  • Intervention on saphenous vein grafts using first-generation DES in patients with prior CABG leads to significantly worse clinical outcomes compared to targeting native coronary arteries.

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