Author + information
- David Shavelle1,
- Neel Kapasi1,
- Subhash Banerjee2,
- Theodore Schreiber3,
- William O'Neill4,
- Jeffrey J. Popma5 and
- Ray Matthews1
- 1University of Southern California, Los Angeles, California, United States
- 2UT Southwestern Medical Center/ VA North Texas Health Care System, Dallas, Texas, United States
- 3Detroit Medical Center, Warren, Michigan, United States
- 4Henry Ford Hospital, Detroit, Michigan, United States
- 5Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Patients with prior coronary artery bypass graft (CABG) surgery represent a high risk cohort given associated medical conditions and worse outcome of saphenous vein graft (SVG) compared to native vessel percutaneous coronary intervention (PCI). The use of hemodynamic support in patients with prior CABG surgery undergoing high risk PCI has not been adequately described.
The goal of the current analysis was to evaluate the association between prior CABG surgery and clinical outcomes in 591 patients with multi-vessel coronary artery disease or unprotected left main disease and severely reduced left ventricular systolic function undergoing Impella supported PCI from the PROTECT II randomized trial and the cVAD Registry. Patients with prior CABG surgery (n=201) were compared to those without prior CABG surgery (n=390). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) at 90 days.
Patients with prior CABG surgery had higher STS mortality score compared to patients without prior CABG surgery, 7.6±6.4 vs 5.1±5.5, respectively, p <0.001. SVG PCI was performed in 29% of patients with prior CABG surgery. Number of vessels treated was lower in patients with prior CABG surgery compared to patients without prior CABG surgery, 1.66±0.56 vs 1.89±0.64, respectively, p < 0.001. Achievement of TIMI 3 flow post PCI and overall PCI success were similar in both groups. MACCE at 90 days was similar in patients with prior CABG surgery compared to patients without prior CABG surgery, 17.2% vs 18.2%, respectively, p = 0.897.
In this high-risk cohort of patients undergoing hemodynamically supported PCI, prior coronary artery bypass graft surgery was not associated with worse outcome. The use of hemodynamic support appears to mitigate the increased risk associated with prior coronary artery bypass graft surgery.
CORONARY: Hemodynamic Support and Cardiogenic Shock