Outcomes of Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Grafting: A Two-Country Perspective.

Background: Coronary artery disease (CAD) is a leading cause of mortality worldwide. Treatments such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are crucial for managing CAD. While CABG is often preferred for complex cases, many patients require PCI due to graft failure or new blockages post-CABG. This study evaluates PCI outcomes in Pakistani and Saudi patients with prior CABG, addressing the scarcity of regional data.

Objective: The primary objective was to measure the success rate of PCI in post-CABG patients, defined as achieving less than 30% residual stenosis without major complications. Secondary objectives included assessing the incidence of restenosis, repeat revascularization, and major adverse cardiac events (MACEs) over one year.

Methods: This one-year prospective cohort study was conducted at multiple tertiary care hospitals in Pakistan and Saudi Arabia, involving 246 participants aged 18 years and older who had previously undergone CABG. Participants underwent PCI using standard procedures. Data were collected on demographic information, clinical characteristics, procedural details, and follow-up outcomes. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with descriptive statistics summarizing the baseline characteristics. The chi-square test or Fisher's exact test compared categorical variables, and the t-test or Mann-Whitney U test was used for continuous variables. A p-value of less than 0.05 was considered statistically significant.

Results:  The mean age of the participants was 63.5 ± 10.2 years, with 73.2% being male. The PCI success rate was 91.5% (95% CI: 88.2-94.8%), with most patients achieving less than 30% residual stenosis. There were 15 cases (6.1%) of MACEs, including five myocardial infarctions (2.0%) and 10 urgent revascularizations (4.1%). Restenosis occurred in 20 patients (8.1%; 95% CI: 4.7-11.5%), and repeat revascularization was required in 18 patients (7.3%; 95% CI: 4.0-10.6%). Kaplan-Meier survival analysis indicated no significant difference in MACE-free survival between patients with and without restenosis (log-rank test, p=0.423).

Conclusion: The high success rate of PCI in post-CABG patients across both Pakistan and Saudi Arabia suggests that it is a viable option even in complex cases. These findings can inform clinical practice, emphasizing the importance of consistent follow-up and tailored interventions to enhance patient outcomes.