Percutaneous revascularization in patients with previous coronary artery bypass graft surgery. Immediate and 1-year clinical outcomes

Background: An increasing number of patients undergoing percutaneous interventions ( PI) have experienced previous coronary artery bypass graft surgery (CABG). However, the impact of PI on outcomes in such patients is currently unclear. We evaluated the immediate and 1-year clinical outcomes of post-CABG patients who underwent PI in a tertiary center. Methods: From January-2005 to September-2006, 91 consecutive post-CABG patients underwent 197 stent implantations (84% drug-eluting stents) for 154 lesions. 58% were treated in the native coronary arteries, 34% in the grafts and 8% in both type of vessels. Major adverse cardiac events (MACE) were recorded in-hospital and at 1-year follow-up. Results: Procedural success rate was 95.6%. In-hospital MACE rate was 3.3%. At 1 year, the incidence of MACE was 18.6%: death occurred in 5.4% of the patients, myocardial infarction in 2.2%, and 10.9% of the patients underwent repeat revascularization ( target lesion revascularization was required in 5.4%). Multivariate analysis revealed left ventricular ejection fraction < 50% (OR 4.6, 95% CI 1.8 to 7.5, p=0.01) and multivessel intervention (OR 2.7, 95% CI 1.2 to 4.5, p=0.03) to be independent predictors of MACE at 1 year. Conclusions: Immediate results showed the safety and efficacy of percutaneous revascularization in post-CABG patients. The relatively low risk need for target lesion revascularization obtained is encouraging. Independent predictors of MACE at 1 year were left ventricular disfunction and multivessel intervention. (c) 2008 Elsevier Ireland Ltd. All rights reserved.