Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients with Prior Coronary Artery Bypass Graft Surgery Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Emmanouil S. Brilakis, Colin I. O'Donnell, William Penny, Ehrin J. Armstrong, Thomas Tsai, Thomas M. Maddox, Mary E. Plomondon, Subhash Banerjee, Sunil V. Rao, Santiago Garcia, Brahmajee Nallamothu, Kendrick A. Shunk, Kreton Mavromatis, Gary K. Grunwald, Deepak L. Bhatt

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Objectives The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. Background Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. Methods A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). Results During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). Conclusions In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)884-893
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume9
Issue number9
DOIs
StatePublished - May 9 2016

Bibliographical note

Funding Information:
Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, and Terumo; and has received research support from InfraRedx and Boston Scientific; and his spouse is an employee of Medtronic. Dr. Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development. Dr. Garcia is a consultant for Surmodics. Dr. Rao is a consultant for Medtronic. Dr. Armstrong is a consultant for Abbott Vascular, Medtronic, Merck, and Spectranetics. Dr. Bhatt is a member of the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is a member of the boards of directors of the Boston VA Research Institute, the Society of Cardiovascular Patient Care; is chair of the American Heart Association Get With the Guidelines Steering Committee; is a member of the data monitoring committees of the Duke Clinical Research Institute, the Harvard Clinical Research Institute, the Mayo Clinic, and the Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org ), Belvoir Publications (editor-in-chief, Harvard Heart Letter), the Duke Clinical Research Institute (clinical trial steering committees), the Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (editor-in-chief, Journal of Invasive Cardiology), the Journal of the American College of Cardiology (guest editor, associate editor), the Population Health Research Institute (clinical trial steering committee), Slack Publications (chief medical editor, Cardiology Today’s Intervention), WebMD (continuing medical education steering committees); is deputy editor of Clinical Cardiology; has received research funding from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; is a site co-investigator for Biotronik and St. Jude Medical; is a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, PLx Pharma, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. government.

Publisher Copyright:
© 2016 American College of Cardiology Foundation.

Keywords

  • bypass graft
  • coronary bypass graft surgery
  • percutaneous coronary intervention

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