Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, clc.24021. https://doi.org/10.1002/clc.24021 Dr. Ru Liu et al.
Points
- This research paper examines the outcomes of percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG), utilizing real-world data limited in this patient population.
- The study included 10,724 patients with coronary artery disease (CAD) who underwent PCI in 2013 and compared outcomes between patients who received PCI on bypass grafts and those who received PCI on native coronary arteries.
- The rates of all-cause death and major adverse cardiovascular and cerebral events (MACCE) did not significantly differ between the two groups at two and five years.
- The risk of revascularization at two years was lower in the graft PCI group. However, the risk of myocardial infarction (MI) at five years was higher than the native artery PCI group.
- While the graft PCI group had a lower risk of revascularization at two years, they had a higher risk of MI at five years compared to the native artery PCI group. However, the two groups had no significant difference in the risk of all-cause death and MACCE at five years.
Summary
This research paper investigates the frequency and outcomes of percutaneous coronary intervention (PCI) in patients who have previously undergone coronary artery bypass grafting (CABG). Real-world data on this specific patient population are limited. A large-sample observational study enrolled 10,724 patients with coronary artery disease (CAD) who underwent PCI in 2013. Outcomes at two and five years were compared between two groups: patients who underwent PCI on bypass grafts and patients who underwent PCI on native coronary arteries.
Among the total cohort, 438 patients had a history of CABG, with 13.7% in the graft PCI group and 86.3% in the native artery PCI group. The rates of all-cause death and major adverse cardiovascular and cerebral events (MACCE) at two and five years did not differ significantly between the two groups. However, the risk of revascularization at two years was lower in the graft PCI group (3.3% vs. 12.4%, p < .05), while the risk of myocardial infarction (MI) at five years was higher (13.3% vs. 5.0%, p < .05). Multivariate COX regression analysis revealed that the graft PCI group had a lower risk of revascularization at two years (hazard ratio [HR]: 0.21; 95% confidence interval [CI]: 0.05–0.88; p = .033) but a higher risk of MI at five years compared to the native artery PCI group (HR: 2.61; 95% CI: 1.03–6.57; p = .042). There was no significant difference between the two groups in the risk of all-cause death and MACCE at five years.
In conclusion, among patients with prior CABG who underwent PCI, those in the graft PCI group had a higher risk of MI at five years than those in the native artery PCI group. However, the two groups had no significant differences in five-year mortality and MACCE. These findings contribute to understanding outcomes in this patient population and may inform clinical decision-making regarding PCI strategies in patients with prior CABG.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24021
References Liu, R., Liu, H., Yuan, D., Chen, Y., Tang, X., Zhang, C., Zhu, P., Yang, T., Zhang, Y., Li, H., Xu, O., Gao, R., Xu, B., & Yuan, J. (2023). For patients with prior coronary artery bypass grafting and recurrent myocardial ischemia, percutaneous coronary intervention on bypass graft or native coronary artery?—A 5‐year follow‐up cohort study. Clinical Cardiology, clc.24021. https://doi.org/10.1002/clc.24021
