Key result
Native vessel PCI increases 1-year MACE ~114% vs SVG PCI in graft failure.
Its licence doesn't allow us to show a copy here.
Why the study?
Guidelines recommend PCI of bypassed native coronary arteries over bypass grafts in patients with graft failure, but this recommendation relies solely on observational data.
Does native vessel PCI improve clinical outcomes compared to saphenous vein graft PCI in patients with prior CABG presenting with graft failure?
RCT (n=220)
Open-label
1:1 using an interactive web-based randomization platform
Yes
Does native vessel PCI improve clinical outcomes compared to saphenous vein graft PCI in patients with prior CABG presenting with graft failure?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“SVG PCI was associated with better outcomes with respect to MACE at 1-year follow-up, which was primarily driven by lower rates of PCI-related MI and clinically driven target coronary territory revascularization. Importantly, these findings apply to patients in whom both strategies are considered technically feasible by the heart team in a cohort with a high prevalence of complex native CTO lesions. These results challenge current guidelines at 1 year follow-up. However, long-term follow-up will be essential to determine whether the early clinical advantage observed with SVG PCI will be maintained over time.”
“It's important to note that these were relatively straightforward saphenous vein graft lesions compared to highly complex native coronary occlusion lesions.”
“When you do a randomized trial like this, you're sort of picking really, really difficult natives and probably more straightforward vein grafts, so it's important to recognize that.”
In patients with prior CABG and SVG failure, SVG PCI was associated with improved 1-year clinical outcomes compared with native vessel PCI, challenging current guideline recommendations.
BACKGROUND In patients with prior coronary artery bypass grafting (CABG) presenting with graft failure, current guidelines recommend percutaneous coronary intervention (PCI) of the bypassed native coronary artery over PCI of the bypass graft. However, this recommendation relies solely on observational data. OBJECTIVES This study compared clinical outcomes between a strategy of native vessel PCI with saphenous vein graft (SVG) PCI in post-CABG patients presenting with SVG failure. METHODS The multicenter, randomized PROCTOR (Percutaneous Coronary Intervention of Native Coronary Artery versus Saphenous Vein Graft in Patients with Prior Coronary Artery Bypass Graft Surgery) trial included patients with significant SVG stenosis and a heart team-defined clinical indication for revascularization. Patients were randomly assigned (1:1) to either a strategy of native vessel PCI or SVG PCI using an interactive web-based randomization platform. The trial was conducted across 14 centers in Europe. We report the occurrence of major adverse cardiac events at 1 year following the index PCI, defined as the composite of all-cause mortality, nonfatal target coronary territory myocardial infarction (MI), or clinically driven target coronary territory revascularization, analyzed on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov (NCT03805048), and long-term follow-up is ongoing. RESULTS Between January 2019 and December 2023, 220 patients (mean age 73 ± 7 years; 84% men [185/220 patients]) were randomized to a strategy of native vessel PCI (n = 108) or SVG PCI (n = 112). At 1 year, major adverse cardiac events occurred in 37 patients (34%) in the native vessel PCI group and 21 patients (19%) in the SVG PCI group (HR: 2.14; 95% CI: 1.25-3.65; P = 0.006). There was no significant difference in all-cause mortality (HR: 1.59; 95% CI: 0.45-5.64; P = 0.472), whereas both nonfatal target coronary territory MI (HR: 2.12; 95% CI: 1.08-4.17; P = 0.029) and clinically driven target coronary territory revascularization (HR: 2.19; 95% CI: 1.02-4.72; P = 0.044) occurred more frequently in patients assigned to native vessel PCI. The incidence of PCI-related MI was 13% in the native vessel PCI group and 1% in the SVG PCI group (HR: 14.85; 95% CI: 1.95-112.96; P = 0.009). CONCLUSIONS In the randomized PROCTOR trial, SVG PCI was associated with improved 1-year clinical outcomes compared with native vessel PCI, primarily driven by lower rates of PCI-related MI and clinically driven target coronary territory revascularization.
No takes yet. Share an insight, caveat, or question.
Winter et al. (2025) conducted an RCT in Prior CABG with saphenous vein graft failure (n=220). Native vessel PCI vs. Saphenous vein graft (SVG) PCI was evaluated on Major adverse cardiac events (composite of all-cause mortality, nonfatal target coronary territory MI, or clinically driven target coronary territory revascularization) at 1 year (HR 2.14, 95% CI 1.25-3.65, p=0.006). Native vessel PCI increased the 1-year risk of major adverse cardiac events compared to saphenous vein graft PCI (34.3% vs 18.7%, HR 2.14) in patients with prior CABG and graft failure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: