TCT-678 Long-Term Outcomes of Revascularization Post Coronary Artery Bypass Surgery

Abstract

Background: Patients with previous coronary artery bypass grafting (CABG) represent almost 10% of patients presenting with ischemic syndromes. Treatment options include percutaneous coronary intervention (PCI) to a failed graft, PCI to a native coronary artery (nvPCI), and optimal medical therapy (OMT). We describe the management of these patients and compare the outcomes according to the mode of treatment. Methods: We identified all patients with prior CABG who underwent coronary angiography in 2015 at 2 large-volume PCI centers in the United Kingdom. Baseline demographics, procedural details, and long-term clinical outcomes (including major adverse cardiovascular events [MACE] and all-cause mortality) were collected. Results: A total of 539 patients with prior CABG had coronary angiography. Ninety-five had saphenous vein graft (SVG) PCI, 216 had nvPCI, and 228 had OMT. Mean duration of follow-up was 31 ± 4 months. During follow-up, MACE was significantly higher in patients treated with SVG PCI compared with those treated with nvPCI or OMT (Figure 1, Table 1). This is driven primarily by a higher rate of acute coronary syndrome. [Figure presented] [Figure presented] Conclusion: There is a significant increase in hazard associated with SVG PCI compared with nvPCI or OMT. With the evolution of chronic total occlusion and complex PCI techniques, SVG PCI should only be used in the acute setting to treat a patient in unstable condition. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)