Long-term Outcomes of Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Grafting

Background: Patients with a prior coronary artery bypass graft (CABG) may have a need for repeat revascularization, which is typically attempted first via percutaneous coronary intervention (PCI) of either a bypass graft or native vessel. Long-term outcomes of native vessel compared with graft PCI after CABG have not yet been explored in a large institution study. Methods: Patients with history of prior CABG who underwent PCI at our institution between 2010-2018 were included. Baseline characteristics and long-term outcomes of up to 5 years were compared between native vessel and bypass graft PCI groups. Cox regression was used to adjust for significant covariates in estimation of risk and calculation of hazard ratios. Results: During the study, 4,251 patients with a prior CABG underwent PCI. Native vessel PCI represented 67.1% (N = 2,851) of the cohort. After adjusting for significant covariates, bypass graft PCI compared with native vessel PCI had a higher risk of overall mortality (HR 1.15; 95% CI, 1.04-1.29; P < 0.05), all-cause readmission (HR 1.16; 95% CI, 1.1-1.3; P < 0.05), readmission for PCI (HR 1.25; 95% CI, 1.13-1.38; P < 0.05), readmission for heart failure (HR 1.16; 95% CI, 1.06-1.26; P < 0.05), and composite of myocardial infarction and revascularization (HR 1.23; 95% CI, 1.12-1.35; P < 0.05). Conclusions: Among patients with prior CABG, bypass graft PCI compared to native vessel PCI was associated with higher risk of adverse long-term outcomes.