Outcome of Percoutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Surgery

Advance progression in percutaneous coronary intervention (PCI) technique, particularly with new advanced drug eluted stents (DES) has made it an effective treatment for many cardiac diseases.

Redo coronary artery bypass surgery (CABG) has higher risk of mortality rather than first operation. Although the positive impression of percoutaneous coronary intervention (PCI) in such symptomatic patents has not proven yet, but different studies have evaluated the outcome of the symptomatic post CABG patients after performing PCI. In this study we aim to find out if PCI could be helpful in such patients. Patients and

In this study, 111 symptomatic patients with pervious history of single coronary artery bypass graft (without concomitant vale surgery) underwent PCI by a single operator between March 2008 and March 2012. Then, they were followed during the following year after PCI and the incidence of death redo CABG, persistent cardiac symptom and rate of hospitalization were recorded

The successful rate of PCI in this study was estimated to be 94.5% (104 of 111). In hospital MACE was 9.6% (three deaths and one myocardial infarction). 67% (73) of patients were male and 33% (33) were female. 79.6% (86) of PCI procedures were done on native coronary arteries and 20.4% (22) on SVG grafts. During one year follow up, we had 7 death in patients with PCI on native vessels (group A) and 1 death in the patients whose PCI was performed on SVG grafts (group B), (P ≥ 0.999). In group A, 27.9% (24) patients were remained symptomatic; while in group B, 18.4% (4) patients were still symptomatic (P = 0.353). Hospitalization because of cardiac syndrome was recorded for 10.5% (9) patients in group A and 9.1% (2) patients of group B (P > 0.955). None of the patients of group B went under redo-CABG during the follow up but 2.3% (2) patients of group A did (P > 0.289). No case of stent restenosis or target vessel revascularization was recorded in either group. The overall rate of death was 7.6% (8 0f 104), persistent cardiac symptoms 27% (28 0f 104), hospitalization for cardiac symptoms 10.5% (11 f 14) and redo CABG 2% (2 of 104).

This study shows that PCI in symptomatic post CABG patients follows by high successful and low complication rate and positive impression on their cardiac symptoms and could reduce the need for redo CABG. It seems that there is no difference that PCI is performing on SVG or native vessel, the intervention itself improves the patients’ quality of life.