Comparison of percutaneous interventions for unstable angina pectoris in patients with and without previous coronary artery bypass grafting

An increasing number of patients who have undergone previous coronary arter y bypass grafting (CABG) are referred for percutaneous coronary revasculari zation. We identified patients who underwent percutaneous intervention for unstable angina from 1990 to 1998 at our institution and assigned them into 2 groups based on whether or not they had undergone previous CABG. There w ere 1,431 patients with and 4,629 patients without previous CABG. Previous CABG patients were older, had more atherosclerotic risk factors, more heart failure, lower ejection fraction, more multivessel disease, more multilesi on treatment, more complex lesions, and less complete revascularization. Ad justing for baseline differences, previous CABG was associated with worse l ong-term mortality (RR 1.47, 95% confidence intervals [CI] 1.22 to 1.77, p <0.001) and death, myocardial infarction, and/or revascularization (RR 1.16 , 95% CI 1.04 to 1.30, p = 0.01); treatment of native lesions in patients w ith previous CABG versus treatment of vein graft lesions was associated wit h a reduction in this composite end point (RR 0.75, 95% CI 0.65 to 0.87, p <0.001). Post-CABG patients treated between 1995 and 1998 had lower long-te rm mortality (RR 0.76, 95% CI 0.59 to 0.99, p = 0.04) and death, myocardial infarction, and/or revascularization (RR 0.76, 95% CI 0.66 to 0.88, p <0.0 01) compared with those treated between 1990 and 1994. Thus, in patients wi th unstable angina referred for percutaneous revascularization, previous CA BG is associated with reduced event-free survival, although the outcome of post-CABG patients treated from 1995 to 1998 is superior to that observed i n patients treated from 1990 to 1994. In patients who underwent previous CA BG, treatment of native lesions affords better long-term outcome than vein graft intervention. (C)2000 by Excerpta Medico, Inc.