New revascularization after coronary artery bypass graft (CABG) is often needed, be it because of severe bridge lesion, intimal hyperplasia, thrombosis, atherosclerosis, or native vessel lesion progression.
We therefore need to determine the best revascularization strategy, namely native or graft percutaneous intervention, venous or arterial, or repeat surgery, with the risk it entails.
There is no clear evidence to support either bridge or native graft PCI as the best option.
With this question in mind, the study looked at 435 PCI procedures performed on CABG patients. Target lesions were 235 on native coronary arteries (54% NA) and the remaining 200 on vein bridges (46% SVG).
There were no differences between populations. Mean age was 70, 14% were women, 40% diabetic, 14% had kidney failure, 1% were on dialysis, 70% had prior MI and 25% prior PCI. Ventricular ejection fraction ≤40% was present in 25%. There was a difference in favor of the SVG group in years between CABG and PCI (12 years vs. 10 years p=0.002) and the need for emergency procedures. (60% vs. 49% p=0.021).
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52% of procedures had femoral access and there was no difference in treated vessel, be it native or graft. There were differences in number of stents (higher in NA group) and diameter (larger in SVG patients) There were no differences in length.
SVG patients received more BMS and final TIMI 3 flow was higher in the NA group. In addition, the presence of no reflow was higher in the SVG group (10% vs. 0.4% p<0.001).
Populations were matched using propensity score, which left 167 patients in each group.
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At 12-month followup, MACE was higher in the SVG group, driven by MI and new revascularization.
At multivariable analysis, SVG were predictors of MACE (hazard ratio [HR] 1.725, 95% confidence interval [CI] 1.049–2.837), driven by the need for new revascularization (HR 2.218, 95% CI 1.193–4.122) and MI (HR 2.248, 95% CI 1.220–4.142), with no difference in mortality at 12 months.
Conclusion
Compared against graft PCI, saphenous vein graft PCI is associated to higher MACE incidence at one year driven mainly by MI and revascularization.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: One-year outcomes of percutaneous coronary intervention in native coronary arteries versus saphenous vein grafts in patients with prior coronary artery bypass graft surgery.
Reference: Amr Abdelrahman, et al. Cardiology Journal 2022, Vol. 29, No. 3, 396–404. DOI: 10.5603/CJ.a2020.0131.
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