Percutaneous coronary interventions in patients with prior coronary arterybypass surgery: Changes in patient characteristics and outcome during two decades

PURPOSE: Patients who develop recurrent myocardial ischemia after coronary artery bypass graft (CABG) surgery are often referred for percutaneous coro nary interventions. The objective of this study was to evaluate the changin g demographic and clinical characteristics, and procedural and long-term ou tcomes, in patients with prior CABG referred for percutaneous coronary inte rventions during a 20-year period. METHODS: We prospectively collected data on patients who underwent coronary interventional procedures following CABG surgery. We compared angiographic and procedural success, and long-term event-free survival, among patients who had procedures from 1979 to 1989 (n = 393), from 1990 to 1994 (n = 811) , and from 1995 to 1998 (n = 937). RESULTS: Patients in the 1995 to 1998 cohort were older, had a lower mean l eft ventricular ejection fraction, and were more likely to have diabetes, h ypertension, and hyperlipidemia, but less likely to smoke. They were more l ikely to have treatment of complex lesions, including vein graft lesions, a nd had more prior CABG surgeries. More patients received intracoronary sten ts in 1995 to 1998. Both angiographic success rates (78% from 1979 to 1989, 88% from 1990 to 1994, and 91% from 1995 to 1998, P <0.0001) and procedura l success rates (78%, 86%, and 91%, P <0.0001) improved with time. Long-ter m mortality was greater in the pre-1990 group (relative risk = 1.8, 95% con fidence interval: 1.3 to 2.4) and 1990 to 1994 group (relative risk = 1.7, 95% confidence interval: 1.3 to 2.2) compared with the 1995 to 1998 group, as were the likelihoods of repeat revascularization and recurrent severe an gina. CONCLUSION: Although the demographic and clinical characteristics of patien ts who underwent percutaneous intervention following CABG surgery indicate that they are at increasingly greater risk of adverse cardiac events, succe ss rates and long-term survival have improved with time. The rates of recur rent severe angina as well as of subsequent revascularization have also dec reased, probably as a result of improvements in technique and greater use o f stents and adjunctive medications. (C) 2000 by Excerpta Medica, Inc.