Related Experiment Video
Updated: Jul 8, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Single-Centre Registry Analysis of Patients Who Underwent Percutaneous Coronary Intervention on Their Coronary Bypass
Wan Cheol Kim1, Gregory Hirsch2, Catherine Kells1
1Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Insights
Percutaneous coronary intervention (PCI) on bypass grafts leads to significant adverse outcomes, including mortality and target vessel failure (TVF), within five years. Management strategies for this high-risk group require further development.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Bypass grafts, particularly saphenous vein grafts, are frequently treated with PCI.
- Outcomes of PCI in bypass grafts are less understood compared to native coronary arteries.
Purpose of the Study:
- To assess the clinical outcomes of patients undergoing PCI on bypass grafts.
- To evaluate rates of all-cause mortality and target vessel failure (TVF) after PCI in bypass grafts.
- To identify factors associated with adverse outcomes in this patient population.
Main Methods:
- A single-center registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019.
- Outcomes assessed included all-cause mortality and TVF (target lesion revascularization, target vessel revascularization, medically treated occluded target graft).
- Multivariable analyses were performed to identify independent predictors of mortality and TVF or death.
Main Results:
- The majority of patients (94.8%) received PCI on saphenous vein grafts, with a median graft age of 13 years.
- One-year mortality was 3.3%, and the combined rate of TVF or death was 20.3%.
- After five years, mortality increased to 14.9%, and the combined TVF or death rate rose to 40.3%.
- Chronic kidney disease was associated with mortality, while hypertension and increased stent length were associated with TVF or death.
Conclusions:
- Patients undergoing PCI on bypass grafts face substantial adverse outcomes, including high rates of mortality and TVF, over a five-year period.
- The findings underscore the complexity and risks associated with treating bypass grafts.
- Further research and refined management strategies are necessary for this high-risk patient cohort.
Background:
The study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates.
Methods:
A single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI.
Results:
The median age of the patients was 71 years (interquartile range: [IQR] 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.16-2.61, P = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, P = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, P = 0.007) were independently associated with the TVF-or-mortality outcome.
Conclusions:
Patients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies