TY - JOUR
T1 - Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft
AU - Beerkens, Frans J.
AU - Singh, Ranbir
AU - Cao, Davide
AU - Claessen, Bimmer E.
AU - Nicolas, Johny
AU - Sartori, Samantha
AU - Snyder, Clayton
AU - Camaj, Anton
AU - Giustino, Gennaro
AU - Power, David
AU - Razuk, Victor
AU - Jones, Davis
AU - Tavenier, Anne H.
AU - Pivato, Carlo Andrea
AU - Nardin, Matteo
AU - Chiarito, Mauro
AU - Krishnan, Prakash
AU - Barman, Nitin
AU - Baber, Usman
AU - Sweeny, Joseph
AU - Dangas, George
AU - Sharma, Samin K.
AU - Mehran, Roxana
AU - Kini, Annapoorna
N1 - Funding Information: Dr. George Dangas reports institutional research grants from Abbott Laboratories, AstraZeneca, Bayer, Boston Scientific, Medtronic, and Daiichi‐Sankyo; consultant fees from Biosensors, Boston Scientific, and speaker honoraria from Chiesi. Dr. Mehran reports institutional research grants from Abbott, Abiomed, Applied Therapeutics, AstraZeneca, Bayer, Beth Israel Deaconess, Boston Scientific, Bristol‐Myers Squibb, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Zoll; personal fees from ACC, Boston Scientific, California Institute for Regenerative Medicine (CIRM), Cine‐Med Research, Janssen, WebMD, SCAI; consultant fees paid to the institution from Abbott Laboratories, Abiomed (spouse), Bayer (spouse), Beth Israel Deaconess, CardiaWave, Chiesi, Concept Medical, DSI, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis; Equity <1% in Applied Therapeutics, Elixir Medical, STEL, CONTROLRAD (spouse); consulting (no fee) from Regeneron Pharmaceuticals; Scientific Advisory Board for AMA. All other authors do not have any other conflicts of interest to disclose. Publisher Copyright: © 2021 Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/11/15
Y1 - 2021/11/15
N2 - 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 < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. Conclusions: Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.
AB - 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 < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. Conclusions: Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.
KW - complex PCI
KW - coronary bypass grafts
KW - no reflow
KW - percutaneous coronary intervention
KW - saphenous vein bypass graft
KW - saphenous vein graft interventions
UR - http://www.scopus.com/inward/record.url?scp=85114494998&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ccd.29935
DO - https://doi.org/10.1002/ccd.29935
M3 - Article
C2 - 34478235
SN - 1522-1946
VL - 98
SP - E785-E795
JO - Catheterization and cardiovascular interventions
JF - Catheterization and cardiovascular interventions
IS - 6
ER -