Repeat intervention after invasive treatment of coronary arteries.

Objective: Patients who undergo successful revascularisation either with coronary artery bypass grafting (CABG) or with percutaneous coronary intervention (PCI) may subsequently require repeat invasive procedures.

Methods: A cohort of 662 coronary artery diseased (CAD) patients was retrospectively reviewed. Follow-up was 36 months.

Results: Thirty-day mortality was 1.0% in the CABG group (n=302) and 0% in the PCI group (n=360) (p=0.094). Overall 3-year survival for the cohort was 95.0% (NS). In addition to repeat angiographies (cumulative frequency 57.7% for PCI vs 4.3% for CABG, p<0.001) patients underwent both repeat PCI (20.7% vs 3.2%, p<0.001) and repeat CABG (6.9% vs 0.7%, p<0.001) during the follow-up. In Cox regression analysis hazard ratio (HR) for repeat PCI after initial PCI was 8.5, 95% confidence interval (CI) 3.7-19.5, p<0.001 and for repeat CABG 9.5, CI 2.2-40.0, p=0.002 in comparison to initial CABG. In-stent restenosis and progression of atherosclerotic plaques in native vessels were reasons for repeat intervention among the PCI patients. Complications with bypass grafts together with progression of the underlying disease were factors for re-interventions after CABG.

Conclusions: PCI is far less invasive and may have lower in-hospital mortality rates than CABG. However, the highly likely need for repeat invasive procedures and revascularisation has to be taken into consideration when choosing an invasive approach for multi vessel CAD patients.