title: Outcomes of percutaneous coronary intervention in patients after previous coronary artery bypass surgery.
abstract: BACKGROUND
  Patients after previous coronary artery bypass grafting (CABG) often require repeat percutaneous revascularisation due to poor patency rates of saphenous vein grafts (SVG) and higher risk of re-CABG. Few data are available to evaluate different percutaneous revascularisation strategies in patients after previous CABG.
  
  
  OBJECTIVE
  To evaluate outcomes of percutaneous coronary intervention (PCI) in patients after previous CABG, including the effect of treatment on the quality of life and symptoms, and secondly to assess the relation between angiographic factors and treatment outcomes
  
  
  METHODS
  This was a prospective observational study which included 78 patients after previous CABG. Following coronary angiography, the patients were assigned to one of three groups: group A (n = 20), PCI of a SVG (PCI SVG); group B (n = 29), PCI of a native coronary artery (PCI NA); group C (n = 29), control group that received medical treatment (MT) only. Duration of follow-up was 12 months.
  
  
  RESULTS
  Compared to MT patients, patients treated with PCI had significantly higher Canadian Cardiovascular Society (CCS) class (2.75 vs. 2.41, p = 0.03) and more frequently had coronary angiography performed due to unstable angina (57% vs. 31%, p = 0.04). Patients in the PCI SVG group had significantly older SVG conduits compared to the PCI NA group (13.4 years vs. 8.2 years, p = 0.005). At 12 months of follow-up, we found a significant improvement in the EQ-5D index of the quality of life, and a significant reduction in CCS class in the PCI SVG group (0.66 vs. 0.7, p = 0.0003, and 2.75 vs. 1.9, p < 0.001, respectively) and in the PCI NA group (0.65 vs. 0.72, p < 0.001, and 2.75 vs. 2.17, p < 0.001, respectively), but no improvement in the MT group. Treatment outcomes did not differ significantly between the three groups (combined endpoint rate 20% vs. 13% vs. 27.5%, p = 0.37). In multivariate analysis, SVG age > 11 years was identified as a significant predictor of poor outcomes in patients treated with PCI after previous CABG.
  
  
  CONCLUSIONS
  PCI in patients after previous CABG does not improve prognosis but significantly improves the quality of life and reduces symptom severity.
authors.affiliation: 1Department and Chair of Cardiology, Medical University of Lodz, Lodz, Poland. zjc.ptr@gmail.com.
authors.forename: Piotr
authors.initials: P
authors.lastname: Zając
authors.forename: Paweł
authors.initials: P
authors.lastname: Życiński
authors.forename: Haval
authors.initials: H
authors.lastname: Qawoq
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Jankowski
authors.forename: Jan
authors.initials: J
authors.lastname: Peruga
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wcisło
authors.forename: Piotr
authors.initials: P
authors.lastname: Pagórek
authors.forename: Jan Z
authors.initials: JZ
authors.lastname: Peruga
authors.forename: Jarosław D
authors.initials: JD
authors.lastname: Kasprzak
authors.forename: Michał
authors.initials: M
authors.lastname: Plewka
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation; D016896:Treatment Outcome
keywords: coronary artery bypass grafting; percutaneous coronary intervention