Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft

• Published in: Catheterization and cardiovascular interventions 2021-11, Vol.98 (6), p.E785-E795
• Main Authors: Beerkens, Frans J., Singh, Ranbir, Cao, Davide, Claessen, Bimmer E., Nicolas, Johny, Sartori, Samantha, Snyder, Clayton, Camaj, Anton, Giustino, Gennaro, Power, David, Razuk, Victor, Jones, Davis, Tavenier, Anne H., Pivato, Carlo Andrea, Nardin, Matteo, Chiarito, Mauro, Krishnan, Prakash, Barman, Nitin, Baber, Usman, Sweeny, Joseph, Dangas, George, Sharma, Samin K., Mehran, Roxana, Kini, Annapoorna
• Format: Article
• Language: English
• Subjects: Angioplasty; Bypass; Clinical trials; complex PCI; Coronary artery; Coronary Artery Bypass - adverse effects; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; coronary bypass grafts; Coronary vessels; Heart; Heart surgery; Humans; Implants; Myocardial infarction; no reflow; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Risk Factors; saphenous vein bypass graft; saphenous vein graft interventions; Stents; Thrombosis; Time Factors; Treatment Outcome; Veins & arteries
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29935

Objectives To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery. Background Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown. Methods We stratified prior CABG patients who underwent PCI at a tertiary‐care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all‐cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post‐PCI. Results Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow‐ and no‐reflow phenomenon was more common in venous graft PCI compared to native vessel PCI (OR 4.78; 95% CI 2.56–8.95; p