title: Feasibility of percutaneous coronary interventions in early postcoronary artery bypass graft occlusion or stenosis.
abstract: BACKGROUND
  With continuing technical advances in percutaneous coronary interventions (PCI) for coronary artery disease (CAD), patients undergoing coronary artery bypass surgery (CABG) often have complex coronary anatomy that is not ideal for PCI. Because of the complex anatomy, these patients have a higher risk of early graft occlusion. The feasibility of PCI in the treatment of early graft occlusion is not well established.
  
  
  METHODS
  A retrospective chart review was performed of patients presenting with recurrent ischemia within three months post-CABG and at one-year follow-up.
  
  
  RESULTS
  Forty-six patients with 156 grafts were identified. Three presented with STEMI, 21 with NSTEMI, 21 with unstable angina, and one with congestive heart failure. Sixty-three grafts were occluded or stenosed (>70%). Twenty-seven grafts (43%) in 17 patients were not amenable to PCI. The other 34 grafts (54%) in 23 patients underwent successful PCI. PCI was performed upon native vessels and occluded grafts with equal frequency. Six patients had patent grafts. At one-year follow-up, six of 23 patients in the PCI group were readmitted with ischemia; five vessels (14%) in four patients had restenosed. There were no deaths. In the group with no PCI, 11 of 23 patients were readmitted with ischemia with one death.
  
  
  CONCLUSIONS
  PCI for early post-CABG occlusion was safely performed in slightly more than half of target vessels. PCI was performed upon native vessels and occluded grafts with equal frequency. After initial PCI success, the clinical target vessel restenosis rate was 14% at one-year follow-up.
authors.affiliation: Department of Cardiology, St. John Hospital & Medical Center, Detroit, Michigan 48236, USA. ameen.abdulmalik@stjohn.org
authors.forename: Ameen
authors.initials: A
authors.lastname: Abdulmalik
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Arabi
authors.forename: Abdulwahhab
authors.initials: A
authors.lastname: Alroaini
authors.forename: Howard
authors.initials: H
authors.lastname: Rosman
authors.forename: Thomas
authors.initials: T
authors.lastname: Lalonde
mesh_terms: D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000209:etiology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors