OUTCOME OF REOPERATIVE CORONARY-BYPASS SURGERY VERSUS CORONARY ANGIOPLASTY AFTER PREVIOUS BYPASS-SURGERY

Background The immediate and long-term outcomes of reoperative coronar y artery bypass surgery (CABG) (n=1561) and catheter-based coronary in tervention (angioplasty) (n=2613) were compared in patients from Emery University Hospitals who had previous CABG. Methods and Results The s urgical and angioplasty procedures and statistical methods were standa rd. Data were collected prospectively and entered into a computerized database. Follow-up was by letter, telephone, or additional events res ulting in readmission. In the angioplasty group, 2.9% required in-hosp ital CABG. Hospital mortality was 1.2% after angioplasty versus 6.8% a fter repeat CABG (P<.0001). Recurrent angina was noted frequently at a bout 4 years and was more common after angioplasty. One-, 5-, and 10-y ear mortalities were 11%, 24%, and 49% after CABG versus 6%, 22%, and 38% after angioplasty. survival corrected for baseline differences did not vary with the choice of procedure. There were more additional pro cedures after angioplasty. Patients undergoing angioplasty may be divi ded into those with procedures only in native coronary arteries (n=154 5), only in vein grafts (n=869), and a mixture (n=199), with respectiv e 10-year survivals of 66%, 56%, and 65% (P<.0001). Conclusions These patients have a high incidence of events both in-hospital and in the l ong term. Although initial mortality was higher after CABG, after base line differences were accounted for, there was no difference in the lo ng term. Patients more frequently have additional procedures after ang ioplasty. Choice of therapy should consider clinical and angiographic suitability and patient preference.