Long-term clinical outcome after percutaneous coronary intervention in grafts vs native vessels in patients with previous coronary artery bypass grafting.
BACKGROUND
The long-term clinical outcome of patients with previous coronary artery bypass grafting (CABG), undergoing percutaneous coronary intervention (PCI) is not clear.


METHODS
Observational, retrospective study of post-CABG patients, who underwent PCI in either a graft or a native vessel.


RESULTS
Out of 221 consecutive patients, those with PCI in both native vessel and graft (N=16) and missing follow-up data (N=15) were excluded. Out of the remaining 190 patients (age 67.9±9.6 years; 90.0% men), the graft-PCI group (N=88) had more occluded native vessels (2.1±0.8 vs 1.6±0.8; P<0.001), and fewer totally occluded grafts (0.55±0.6 vs 0.75±0.8; P=0.05) compared with the native vessel-PCI group (N=102). On follow-up (median duration 28 months), the incidence of major adverse cardiac events (MACEs), cardiac death, and repeat revascularization was higher in graft-PCI group compared with native vessel-PCI group (43.2% vs 19.6%, log-rank P<0.001; 19.3% vs 6.9%, log-rank P=0.008; and 23.9% vs 12.7%, log-rank P=0.02, respectively). Graft-PCI was independently associated with higher risk for major adverse cardiac events (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.45-5.57; P=0.002), cardiac death (HR, 3.44; 95% CI, 1.16-10.22; P=0.03) and repeat revascularization (HR, 2.41; 95% CI, 1.02-5.72; P=0.046).


CONCLUSIONS
Post-CABG patients, undergoing graft compared with native vessel-PCI, have worse long-term clinical outcome. Prospective studies are needed to elucidate the optimal revascularization strategy for such patients.
Patras University Hospital, Cardiology Department, Patras, Greece. jxanthop@yahoo.gr
Ioanna
I
Xanthopoulou
Periklis
P
Davlouros
Grigorios
G
Tsigkas
Aggeliki
A
Panagiotou
Georgios
G
Hahalis
Dimitrios
D
Alexopoulos
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors