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.