Author + information
- Jamie Elizabeth Diamond,
- Bjorn Redfors,
- Philippe Genereux,
- Mahesh Madhavan,
- Ajay Kirtane,
- Pieter Smits,
- Roxana Mehran,
- Rupa Caprihan and
- Ori Ben-Yehuda, Gregg Stone
Background: Previous studies have shown that the risk of adverse ischemic events after percutaneous coronary intervention (PCI) is high among patients with prior coronary artery bypass grafting (CABG); however large-scale prospective studies with long-term follow up are scarce.
Methods: We pooled individual patient-level data from 17 randomized drug-eluting stent (DES) trials (N=21,820 patients) and studied the association between prior CABG and adverse outcomes. The outcomes of interest were all-cause death, myocardial infarction (MI), stent thrombosis (ST), and target vessel failure (TVF), defined as the composite of cardiac death, MI and ischemia-driven target vessel revascularization at five years. Multivariable Cox proportional hazards regression analysis stratified by study was performed including the variables age, diabetes, sex, hypertension, hyperlipidemia, current smoking, previous MI, previous PCI, moderate or severe coronary calcification, lesion length and prior CABG.
Results: Among the entire cohort, 1,399 (6.4%) had prior CABG. Compared to patients without prior CABG, patients with prior CABG were more likely to be male and had more cardiovascular risk factors such as diabetes, hypertension, ejection fraction <40%, and prior PCI. At 5 years, patients with versus without prior CABG had higher risk of all-cause death (adjusted hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.19-1.69, p<0.001), MI (adjusted HR 1.30, 95% CI 1.04-1.61, p=0.02), and TVF (adjusted HR 1.41, 95% CI 1.24-1.60, p<0.001). The adjusted risk of ST was similar between the two groups (adjusted HR 0.98, 95% CI 0.63-1.53, p=0.22).
Conclusions: Patients with prior CABG undergoing PCI had higher 5-year adjusted rates of adverse cardiac events, including death, compared to those without prior CABG. New approaches are required to improve the prognosis of high-risk patients with prior CABG.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: PCI and TAVR in Complex Patients
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1239-117
- 2017 American College of Cardiology Foundation