Abstract 13852: Improved Long-Term Survival With Repeat Coronary Bypass Surgery Compared to Percutaneous Coronary Intervention After Previous Surgical Revascularization a 20 Year Experience
Introduction: We compared outcome of repeat CABG (RCABG) and PCI in patients with previous CABG.
Hypothesis: RCABG may improve survival versus PCI.
Methods: From 1993 through 2009, 3,058 patients underwent revascularization after previous CABG. RCABG patients (n=530) were grouped by the use of arterial grafts (n=396), or saphenous vein grafts (SVG; n=134). At previous CABG, 37% of RCABG patients received IMA graft. PCI patients (n=2,528) were grouped into balloon angioplasty (BA; n=491), bare metal stent (BMS; n=1,267), and drug-eluting stent (DES; n=769). PCI patients were further stratified by the treated target into native coronary artery (n=1,637), bypass grafts (n=674), or both (n=216). Propensity score analysis matched 287 patients.
Results: RCABG had increased 30-day mortality compared with PCI (HR=3.92; 95% CI, 2.25-6.84; P<.001) in multivariable analysis, while in propensity matched analysis it did not (P=.09). Overall survival, however, was greater for RCABG compared with PCI in multivariable analysis (HR=0.70; 95% CI, 0.59-0.83; P<.001), as well as in propensity matched analysis (10-year survival rates were 52% vs 37%, respectively [P=.005]). Compared with RCABG, PCI involving bypass grafts had increased mortality (HR, 1.39; 95% CI, 1.09-1.78; P=.008), whereas PCI targeting only the native coronaries did not (HR, 1.12; 95% CI, 0.85-1.47;P=.43); BMS patients had increased mortality (HR, 1.34; 95% CI, 1.06-1.68; P=.013), but DES did not (HR, 1.28; 95% CI, 0.77-2.12; P=.35). At RCABG, 318 patients (60%) received an IMA graft and late survival was similar to those receiving SVG; The use of IMA in previous CABG was associated with improved survival (HR=0.82; 95% CI, 0.72-0.92; P <.001].
Conclusions: Long-term survival after previous CABG is improved with RCABG compared to PCI, especially when PCI involves bypass grafts. There is no difference in long-term survival between RCABG using arterial grafts vs SVG only if IMA is used in either previous or RCABG.
- Coronary artery disease
- Coronary artery bypass grafting (CABG)
- Percutaneous coronary intervention (PCI)
Author Disclosures: L.E. Greiten: None. H.V. Schaff: None. J.M. Stulak: None. S.M. Said: None. K.L. Greason: None. R.C. Daly: None. D.L. Joyce: None. S. Maltais: None. B.D. Lahr: None. C.N. Heins: None. J.A. Dearani: None. A. Lerman: None. C. Locker: None.
- © 2016 by American Heart Association, Inc.