Long-term Outcomes of Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Grafting
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Published on: March 27, 2018
Stephen T Broughton1, Edgar Aranda-Michel2, Ahmet Sezer3
1University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, PA. broughtonst@upmc.edu.
Insights
Percutaneous coronary intervention (PCI) of bypass grafts after coronary artery bypass graft (CABG) surgery is linked to worse long-term outcomes than native vessel PCI. This includes higher risks of mortality, readmission, and major adverse cardiac events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- Patients with prior coronary artery bypass graft (CABG) surgery may require repeat revascularization.
- Percutaneous coronary intervention (PCI) is a common approach for repeat revascularization, targeting either native vessels or bypass grafts.
- Limited data exists on the comparative long-term effectiveness of native vessel versus bypass graft PCI in patients with prior CABG.
Purpose of the Study:
- To compare the long-term outcomes of native vessel PCI versus bypass graft PCI in patients with a history of CABG.
- To identify potential differences in mortality, readmission rates, and major adverse cardiac events between the two PCI strategies.
Main Methods:
- Retrospective analysis of 4,251 patients who underwent PCI after prior CABG between 2010 and 2018.
- Comparison of baseline characteristics and up to 5-year long-term outcomes between native vessel PCI and bypass graft PCI groups.
- Utilized Cox regression analysis to adjust for significant covariates and estimate hazard ratios for adverse outcomes.
Main Results:
- Native vessel PCI was performed in 67.1% of the cohort.
- Bypass graft PCI was associated with a significantly higher risk of overall mortality (HR 1.15) compared to native vessel PCI.
- Bypass graft PCI also showed increased risks for all-cause readmission (HR 1.16), PCI-related readmission (HR 1.25), heart failure readmission (HR 1.16), and a composite of myocardial infarction and revascularization (HR 1.23).
Conclusions:
- In patients with prior CABG, PCI of bypass grafts is associated with poorer long-term clinical outcomes compared to native vessel PCI.
- These findings suggest a need for careful consideration when selecting PCI targets in patients with previous CABG.
- Further research may explore strategies to mitigate the risks associated with bypass graft PCI.
Abstract:
BACKGROUND Patients with a prior coronary artery bypass graft (CABG) may have a need for repeat revascularization, which is typically attempted first via percutaneous coronary intervention (PCI) of either a bypass graft or native vessel. Long-term outcomes of native vessel compared to graft PCI after CABG have not yet been explored in a large institution study. METHODS Patients with history of prior CABG who underwent PCI at our institution during 2010-2018 were included. Baseline characteristics and long-term outcomes of up to 5 years were compared between native vessel and bypass graft PCI groups. Cox regression was used to adjust for significant covariates in estimation of risk and calculation of hazard ratios. RESULTS During the study, 4,251 patients with a prior CABG underwent PCI. Native vessel PCI represented 67.1% (n=2,851) of the cohort. After adjusting for significant covariates, bypass graft PCI compared to native vessel PCI had a higher risk of overall mortality (HR 1.15; 95% CI, 1.04-1.29; p<0.05), all-cause readmission (HR 1.16; 95% CI, 1.1-1.3; p<0.05), readmission for PCI (HR 1.25; 95% CI, 1.13-1.38; p<0.05), readmission for heart failure (HR 1.16; 95% CI, 1.06-1.26; p<0.05), and composite of myocardial infarction and revascularization (HR 1.23; 95% CI, 1.12-1.35; p<0.05). CONCLUSIONS Among patients with prior CABG, bypass graft PCI compared to native vessel PCI was associated with higher risk of adverse long-term outcomes.
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