[Initial results and long-term outcome of percutaneous coronary intervention in patients with previous coronary artery bypass grafting].

OBJECTIVES

The incidence of percutaneous coronary intervention following bypass surgery(coronary artery bypass grafting: CABG) is not low, but the outcomes of patients requiring percutaneous coronary intervention after CABG are not well known.

METHODS

From June 1970 to June 2000, 2,981 patients underwent CABG at our institute using 6,747 grafts including 2,875 saphenous vein graft(SVG), 3,042 internal thoracic artery(ITA), 706 gastro-epiploic artery(GEA), 122 radial artery(RA), and 2 others. Three hundred twenty-seven patients underwent subsequent percutaneous coronary intervention in 520 lesions(104 SVG, 97 ITA, 12 GEA, 8 RA, 299 native artery). The initial results and long-term outcome following percutaneous coronary intervention in these 520 consecutive procedures were evaluated retrospectively.

RESULTS

Percutaneous coronary intervention to arterial grafts were performed mainly within the early post-operative period, whereas percutaneous coronary intervention to vein grafts had two periodic peaks in the early post-operative period and at 7 years after CABG. Procedural success rate of percutaneous coronary intervention was 90% for SVG, 81% for ITA, 58% for GEA, 88% for RA, and 87% for native arteries. Restenosis rate was 56% for SVG, 30% for ITA, 83% for GEA, 83% for RA, and 49% for native arteries. Cardiac events after percutaneous coronary intervention with previous CABG were greater in cases of ITA, followed by native arteries, SVG, GEA and RA(p = 0.0046). In the early post-operative period, there was no significant difference between ITA and SVG. In the chronic stage, the prognosis of cardiac events after PCI for SVG was worse than for ITA.

CONCLUSIONS

Percutaneous coronary intervention after CABG requires strategic consideration based on target-specific initial results and long-term outcome.