Key result
Native vessel PCI shows no survival benefit over graft-PCI in post-CABG patients.
Why the study?
The prognosis and risk factors associated with graft-PCI versus native vessel PCI and DES versus BMS implantation following CABG were not well defined.
Does native vessel-PCI and DES implantation improve MACE-free survival compared to graft-PCI and BMS implantation in patients requiring revascularization following CABG?
Cohort (n=289)
No
Does native vessel-PCI and DES implantation improve MACE-free survival compared to graft-PCI and BMS implantation in patients requiring revascularization following CABG?
Absolute Event Rate: 94.7% vs 90.7%
p-value: p=0.099
In patients requiring PCI after CABG, targeting the native vessel and using drug-eluting stents are associated with significantly better long-term outcomes and fewer major adverse cardiac events.
Native vessel PCI shows no survival benefit over graft-PCI post-CABG; hypothesis-generating and should not change practice.
The purpose of this study was to compare the prognosis of graft-percutaneous coronary intervention (PCI) and native vessel (NV)-PCI, drug-eluting stents (DESs) and bare-metal stents (BMSs) for the treatment of graft lesions following coronary artery bypass grafting (CABG), and to determine the risk factors for major adverse cardiac events (MACEs). A total of 289 patients who underwent PCI following CABG between August 2005 and March 2010 were retrospectively analyzed. The effects on survival were compared among patients who underwent NV- and graft-PCI, and DES and BMS implantation. Additionally, the risk factors for MACEs following PCI for graft lesions were analyzed. The findings showed that MACE-free and revascularization-free survival rates were significantly higher in the NV-PCI group compared with those in the graft-PCI group. There were 63 cases (29.0%) of MACEs in the DES group and 25 cases (52.1%) in the BMS group. In patients undergoing NV-PCI, the DES group had significantly fewer MACEs and less target vessel revascularization (TVR) than the BMS group. In patients undergoing graft-PCI, the DES group showed a tendency for fewer MACEs and a lower incidence of cardiac mortality, myocardial infarction and TVR compared with the BMS group. Diabetes, an age of >70 years and graft-PCI were independent risk factors for MACEs in patients post-PCI. It is concluded that NV-PCI has superior long-term outcomes compared with graft-PCI, and should therefore be considered as the first-line treatment for graft disease following CABG. Despite this, graft-PCI remains a viable option. DESs are the first choice for graft-PCI due to their safety and efficacy and their association with reduced mortality and MACE rate. Diabetes, older age and graft-PCI are independent risk factors for MACEs in patients post-CABG who are undergoing revascularization.
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Liu et al. (2015) conducted a cohort in Graft lesions following coronary artery bypass grafting (CABG) (n=289). Native vessel percutaneous coronary intervention (NV-PCI) vs. Graft percutaneous coronary intervention (graft-PCI) was evaluated on All-cause mortality (reported as overall survival) (p=0.099). Native vessel PCI did not significantly improve overall survival compared to graft-PCI (94.7% vs 90.7%, p=0.099) in patients undergoing revascularization post-CABG.
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