Outcomes of Complex Native Vessel PCI After Bypass Graft Occlusion in Patients With Prior CABG

Limited data exist on outcomes in patients with prior coronary artery bypass grafting (CABG) who, after bypass graft failure, undergo complex percutaneous coronary intervention (PCI) of the corresponding native vessel.

To compare outcomes of complex native vessel PCI in patients with and without prior CABG.

We retrospectively analyzed patients who underwent PCI of native vessels with complex lesions (calcified and ACC/AHA Type B2/C) at our catheterization laboratory between January 2012 and February 2020. Patients undergoing PCI to left main coronary artery, left anterior descending artery, and graft vessels were excluded. The primary endpoint was technical success (residual disease < 30% with TIMI grade 3 flow). Secondary endpoints included a composite of complications, and 30-day and 1-year major adverse cardiac events (MACE).

Among 1508 eligible patients, 264 (17.5%) had a history of CABG with occluded grafts to the corresponding native vessels, while 1244 (82.5%) did not. Patients with prior CABG were older, predominantly male, had more comorbidities, and had lower left ventricular ejection fraction. Technical success (95.8% vs. 96.1%; p = 0.864) and composite of complications (11.0% vs. 12.0%; p = 0.647), were similar between groups. MACE at 30-days (1.9% vs. 2.1%; p = 0.837) and 1-year (12.1% vs. 11.6%; p = 0.812), as well as individual components of MACE, were comparable.

Patients with prior CABG undergoing PCI of complex native vessel lesions after graft occlusion have similar 30-day and 1-year outcomes compared to those without prior CABG. These findings demonstrate that complex native vessel PCI can be safely and effectively performed in this high-risk population.