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Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis

Dimitrios Strepkos1, Michaella Alexandrou1, Deniz Mutlu1

  • 1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|May 29, 2025
PubMed

Insights

Patients with prior coronary artery bypass graft surgery (CABG) undergoing bifurcation percutaneous coronary intervention (PCI) have a lower risk of side branch occlusion but a higher rate of target vessel revascularization. PCI involving bypass grafts showed similar outcomes to native vessel PCI.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Bifurcation percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery (CABG) remains understudied.
  • Understanding the nuances of PCI in this specific patient group is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To compare the clinical, procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.
  • To evaluate the safety and efficacy of PCI in patients with prior CABG, including graft involvement.

Main Methods:

  • A comparative analysis of 1305 patients undergoing 1496 bifurcation PCIs between 2014 and 2024.
  • Inclusion of patients with and without prior CABG, assessing technical success, procedural success, and adverse events.
  • Analysis of short- and long-term outcomes, including target vessel revascularization and side branch occlusion.

Main Results:

  • Patients with prior CABG were older, had more cardiovascular risk factors, and higher angiographic complexity.
  • Technical and procedural success rates were similar between groups; provisional stenting was less frequent in prior CABG patients.
  • Prior CABG patients had lower rates of side branch occlusion but higher rates of target vessel revascularization during follow-up.

Conclusions:

  • Bifurcation PCI in prior CABG patients is associated with a reduced risk of side branch occlusion and an increased risk of follow-up target vessel revascularization.
  • Percutaneous coronary intervention involving a bypass graft in prior CABG patients demonstrated comparable in-hospital and follow-up outcomes to native vessel PCI.
Abstract

Keywords:
BifurcationCoronary artery bypass graftPercutaneous coronary interventionSide branch occlusionTarget vessel revascularization

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