PCI in patients with coronary artery disease and previous CABG: acute and long-term results

ABSTRACT

Cross-talk between PCI and surgeryAims: Ten years after the CABG, roughly 50% of the venous grafts are occludedor with severe obstructions, diminishing the benefits of the surgical procedure atlong term. In this context, percutaneous coronary intervention (PCI) with stentimplantation has evolved as a less invasive alternative to treat these patients.Methods and results: This is a single-center study including all consecutivepatients with previous CABG who were referred to cardiac catheterisation due torecurrence of angina or presence of ischaemia in non-invasive tests betweenDecember 2008 and December 2009. We sought to determine the incidence ofdeath, AMI, stroke and repeat revascularisation (RR) at 30 days and 2 yearsamong patients who were selected to undergo PCI. A total of 751 patients wereenrolled, 108 were treated with PCI and 31 underwent a second CABG (14% and4.1% of those referred to coronariography respectively). The mean age in the PCIgroup was 67 years with 80% of men, and a high overall prevalence of diabetes(45%), hypertension (88%) and chronic renal disease (21%). The reason forcardiac catheterisation was recurrent angina in 87% of the cases (stablesymptoms in 53.4% and acute coronary syndrome in 33.6%). Single-vessel PCIwas performed in most cases (93.1%), being the LAD territory the most frequentlyintervened (31.8%) and native arteries treated more frequently than vein grafts(61.4% vs. 38.6%). Complete revascularisation was achieved in only 47.4% ofthe cases. The rate of success for PCI was 97% and the following 30-dayscomplications were detected 0.9% cardiac death, 2.8% AMI and 0.9% stroke.