Percutaneous Revascularization of Grafts versus Native Coronary Arteries in Postcoronary Artery Bypass Graft Patients

Abstract

In patients with previous coronary artery bypass graft surgery, it is unknown whether better results may be obtained with percutaneous interventions of grafts versus native arteries. The clinical outcomes in 84 patients undergoing percutaneous interventions of either grafts (n = 31) or native arteries (n = 53) were compared. Procedural success rate was 95.3% (96.8% in the graft group vs 94.4% in the native group, P = .3). Mean follow-up was 19 ± 7 months. The incidence of major adverse events was 14.2% (12.9% vs 15.1% in the graft and native groups, respectively; P = .8), mortality rate was 3.5% (6.4% vs 1.8% in the graft and native groups, respectively; P = .3), and target-lesion revascularization was performed in 4.7% (6.4% vs 3.7% in the graft and native groups, respectively, P = .6). In conclusion, both graft or native percutaneous interventions were similar for immediate and midterm clinical outcomes. The relatively low risk need for target-lesion revascularization obtained with both strategies is encouraging.

Percutaneous Coronary Intervention of Native Artery Versus Bypass Graft in Patients with Prior Coronary Artery Bypass Graft Surgery

“…Most studies reported outcomes in a small number of patients (n < 100) and have shown variable results. The revascularized bypass graft was mostly a SVG with only a few studies reporting outcomes derived also from arterial grafts [16][17][18][19][20][21][22], which generally represent around 2% of all bypass graft PCI [23].…”

“…Clinical experience with embolic protection devices has shown that the capture and retrieval of large debris reduces periprocedural adverse events, especially in large SVGs. However, in our review, in 17 observational studies [17][18][19][20][21][22]24,25,[28][29][30][32][33][34]36,38,39], and of 24,382 patients who had bypass graft PCI, only 4,487 (18.4%) had an embolic protection device used (Table 1). There are many plausible explanations for the low penetration of these devices in SVG PCI.…”