Comparison of percutaneous coronary intervention in native coronary arteries vs. bypass grafts in patients with prior coronary artery bypass graft surgery☆☆☆

Abstract 

Objective

To compare the procedural and clinical outcomes of prior coronary artery bypass graft surgery (CABG) patients undergoing percutaneous coronary intervention (PCI) in native arteries vs. bypass grafts.

Methods

The medical and catheterization records and the angiograms of 142 consecutive prior CABG patients who underwent 165 PCI of 247 lesions at our institution between January 1, 2003, and December 31, 2006, were retrospectively reviewed.

Results

Mean age was 66±10 years and 99% were men: 79 and 63 patients underwent native coronary or bypass graft PCI, respectively. Compared to patients undergoing bypass graft PCI, those undergoing native coronary artery PCI were younger (mean age 64±10 vs. 68±10 years, P=.008), more likely to present with stable angina (29% vs. 8%, P=<.001), and presented earlier after CABG (after a mean of 9±6 vs. 12±5 years, P<.01). Compared to bypass graft PCI, native coronary PCI was more likely to be performed with drug-eluting stents (88% vs. 57%, P<.001) and was associated with lower risk of no-reflow (3% vs. 24%, P<.001). After a mean follow-up of 2.5±1.1 years, both groups of patients had similar but high incidence of myocardial infarction, repeat PCI, and death.

Conclusions

Prior CABG patients undergoing native coronary artery PCI have lower procedural risk, but similar postprocedural clinical outcomes compared to patients undergoing bypass graft PCI. If feasible, native coronary arteries may be the preferred PCI target in prior CABG patients.

Abbreviations: CABG, coronary artery bypass graft surgery, CAD, coronary artery disease, MI, myocardial infarction, PCI, percutaneous coronary intervention, SVG, saphenous vein graft, TIMI, Thrombolysis In Myocardial Infarction.

Keywords: Coronary artery bypass graft surgery, Percutaneous coronary intervention, Stents