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Percutaneous Coronary Intervention in Native Arteries Versus Bypass Grafts in Prior Coronary Bypass Grafting Patients: A Report From the National Cardiovascular Data Registry
Study Questions:
What are the frequency, predictors, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery (CABG)?
Methods:
The investigators analyzed the frequency and factors associated with native versus bypass graft PCI in prior CABG patients undergoing PCI between January 1, 2004, and June 30, 2009, in the NCDR® CathPCI Registry®. Generalized estimating equations logistic regression modeling was used to generate independent variables associated with native versus bypass graft PCI and in-hospital mortality.
Results:
During the study period, PCI in prior CABG patients represented 17.5% of the total PCI volume (300,902 of 1,721,046). The PCI target was a native coronary artery in 62.5% and a bypass graft in 37.5%: saphenous vein graft (SVG) (104,678 [34.9%]), arterial graft (7,517 [2.5%]), or both arterial graft and SVG (718 [0.2%]). Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher-risk characteristics and more procedural complications. On multivariable analysis, several parameters (including graft stenosis and longer interval from CABG) were associated with performing native coronary PCI, and bypass graft PCI was associated with higher in-hospital mortality (adjusted odds ratio, 1.22; 95% confidence interval, 1.12-1.32).
Conclusions:
The authors concluded that compared with native coronary PCI, bypass graft PCI is independently associated with higher in-hospital mortality.
Perspective:
This study suggests that most PCIs performed in prior CABG patients are done in native coronary arteries, most bypass graft PCIs are done in SVGs, and patients undergoing bypass graft PCI have higher-risk clinical characteristics and higher in-hospital mortality. A novel finding of this study was that in-hospital mortality after arterial graft PCI was similar to SVG PCI and significantly higher than native coronary interventions. Based on these data, PCI of a native coronary artery should be the preferred approach in post-CABG patients whenever feasible, if revascularization is clinically indicated.
Keywords: Registries, Hospital Mortality, Saphenous Vein, Constriction, Pathologic, Coronary Vessels, Coronary Artery Bypass, Percutaneous Coronary Intervention
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