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Trends of repeat revascularization choice in patients with prior coronary artery bypass surgery

Mohamed O Mohamed1,2, Ahmad Shoaib1,2, Bill Gogas3

  • 1Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 5, 2020
PubMed

Insights

The rate of repeat coronary artery bypass grafting (CABG) doubled in the U.S. from 2004-2015. Redo CABG patients faced worse outcomes, including higher mortality and complications, compared to percutaneous coronary intervention (PCI).

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Health Services Research

Background:

  • Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
  • Repeat revascularization strategies are increasingly utilized in patients with prior CABG.
  • Understanding trends and outcomes of repeat revascularization is crucial for patient care.

Purpose of the Study:

  • To investigate the trends in repeat revascularization strategies (PCI and CABG) in patients with a history of CABG.
  • To identify predictors for undergoing repeat revascularization.
  • To analyze in-hospital outcomes associated with different revascularization strategies.

Main Methods:

  • Retrospective analysis of the National Inpatient Sample database (2004-2015).
  • Inclusion of patients hospitalized for revascularization with a history of CABG.
  • Use of regression analyses to determine predictors and outcomes.

Main Results:

  • The rate of redo CABG doubled from 5.3% to 10.3% between 2004 and 2015.
  • Redo CABG patients were more comorbid and experienced significantly worse outcomes: major adverse cardiovascular and cerebrovascular events (OR 5.36), mortality (OR 2.84), bleeding (OR 5.97), and stroke (OR 2.15).
  • Thoracic complications were notably high (8%) in redo CABG patients, particularly females. Male sex, age <80, and absence of diabetes/renal failure favored redo CABG.

Conclusions:

  • Reoperation rates for patients with prior CABG have doubled in the US over 12 years.
  • Patients undergoing redo CABG represent a more complex population with poorer clinical outcomes compared to those receiving PCI.
  • These findings highlight the need for careful patient selection and risk stratification for repeat revascularization procedures.
Abstract

Keywords:
outcomespercutaneous coronary interventionredo CABGreoperationrevascularization

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