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Am J Cardiol. 2013 Oct 15;112(8):1110-9. doi: 10.1016/j.amjcard.2013.05.056. Epub 2013 Jul 2.

Percutaneous coronary intervention in patients with previous coronary artery bypass grafting (from the j-Cypher Registry).

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  • 1Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

Abstract

A paucity of data is available from large-scale studies evaluating the long-term outcomes of percutaneous coronary intervention in patients who had previously undergone coronary artery bypass grafting (CABG) in the drug-eluting stent era. Of 12,812 patients who had undergone sirolimus-eluting stent implantation in the j-Cypher registry, 919 (7.2%) had a history of CABG and had significantly higher crude 5-year mortality (19.9% vs 14.0%, p <0.001). After adjusting for confounders, the excess risk of death was no longer significant (hazard ratio 0.99, 95% confidence interval 0.83 to 1.18, p = 0.90), and the adjusted risk of target lesion revascularization was significantly higher in patients with previous CABG than in those without (hazard ratio 1.25, 95% confidence interval 1.06 to 1.47, p = 0.01). Of the patients with previous CABG, those who had undergone ≥1 saphenous vein graft intervention had significantly higher adjusted risks of cardiac death (hazard ratio 2.21, 95% confidence interval 1.26 to 3.76, p = 0.01), myocardial infarction (hazard ratio 2.56, 95% confidence interval 1.10 to 5.60, p = 0.03), target lesion revascularization (hazard ratio 2.65, 95% confidence interval 1.82 to 3.81, p <0.001), and definite stent thrombosis (hazard ratio 7.70, 95% confidence interval 1.99 to 29.1, p = 0.004) compared with those who underwent percutaneous coronary intervention only for the native coronary artery. In conclusion, the adjusted mortality was similar between patients with and without previous CABG, despite a significantly different risk of target lesion revascularization. Among the patients with previous CABG, those with saphenous vein graft intervention using a first-generation drug-eluting stent had worse clinical outcomes than those with a native coronary artery target only.

Copyright © 2013 Elsevier Inc. All rights reserved.

PMID:
23827399
[PubMed - indexed for MEDLINE]
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