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CHARACTERISTICS AND OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITHIN ONE YEAR OF CORONARY ARTERY BYPASS GRAFTING SURGERY
E298 JACC March 27, 2012 Volume 59, Issue 13
ACC-i2 with TCT CHARACTERISTICS AND OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITHIN ONE YEAR OF CORONARY ARTERY BYPASS GRAFTING SURGERY i2 Oral Contributions McCormick Place South, S102c Sunday, March 25, 2012, 8:00 a.m.-8:10 a.m.
Session Title: PCI in Complex Patients Abstract Category: 12. PCI - Complex Lesions, Multivessel Disease Presentation Number: 2505-6 Authors: Mark A. Kotowycz, Anirban Choudhury, Lauren M. Morrison, mark osten, Vladimir Dzavik, Chris Overgaard, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada Background: Coronary artery bypass grafting surgery (CABG) remains the preferred strategy for revascularization of patients with complex left main or three vessel coronary artery disease because it is associated with a lower rate of repeat revascularization than percutaneous coronary intervention (PCI). Despite advances in surgical technique and medical therapy, over 5% of patients treated with CABG will require repeat revascularization within 1 year of surgery. The goal of this study was to examine the clinical and procedural characteristics and outcomes of patients who undergo PCI within 1 year of CABG. Methods: A prospective registry with data on over 20,000 PCI procedures was used to identify patients who underwent PCI within 1 year of CABG, between April 1, 2000 and June 30, 2011. Results: In total, 268 patients were identified (mean age 63 years, 72% male) with the following clinical characteristics: hypertension (72%), hypercholesterolemia (83%), diabetes (38%), smoking history (59%), and ejection fraction <40% (19%). The rate of PCI per month was equally distributed throughout the first year after CABG. 45% of patients had elective PCI for recurrence of symptoms while the remaining 55% had PCI on an urgent basis, 3% with acute ST-elevation myocardial infarction, and 1% in cardiogenic shock. PCI most often occurred in native coronary arteries (80%), usually following graft failure in a previously grafted vessel. Of graft PCIs, 87% occurred in venous and 13% in arterial conduits. PCI was successful in 94% of cases. The rate of in-hospital major adverse cardiovascular events (death, MI or stroke) was 1.9%. The rate of major bleeding was 1.9%. Conclusions: Patients requiring PCI within 1 year of CABG are more likely to present for repeat PCI on an urgent basis. Most PCI procedures in this cohort are performed in native coronary vessels that were originally grafted. Further studies are needed to determine whether the use of hybrid revascularization strategies (combination CABG and planned PCI) in appropriate vessels could reduce the need for urgent PCI within the first year after CABG.
ACC-i2 with TCT CHARACTERISTICS AND OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITHIN ONE YEAR OF CORONARY ARTERY BYPASS GRAFTING SURGERY i2 Oral Contributions McCormick Place South, S102c Sunday, March 25, 2012, 8:00 a.m.-8:10 a.m.
Session Title: PCI in Complex Patients Abstract Category: 12. PCI - Complex Lesions, Multivessel Disease Presentation Number: 2505-6 Authors: Mark A. Kotowycz, Anirban Choudhury, Lauren M. Morrison, mark osten, Vladimir Dzavik, Chris Overgaard, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, Toronto, Canada Background: Coronary artery bypass grafting surgery (CABG) remains the preferred strategy for revascularization of patients with complex left main or three vessel coronary artery disease because it is associated with a lower rate of repeat revascularization than percutaneous coronary intervention (PCI). Despite advances in surgical technique and medical therapy, over 5% of patients treated with CABG will require repeat revascularization within 1 year of surgery. The goal of this study was to examine the clinical and procedural characteristics and outcomes of patients who undergo PCI within 1 year of CABG. Methods: A prospective registry with data on over 20,000 PCI procedures was used to identify patients who underwent PCI within 1 year of CABG, between April 1, 2000 and June 30, 2011. Results: In total, 268 patients were identified (mean age 63 years, 72% male) with the following clinical characteristics: hypertension (72%), hypercholesterolemia (83%), diabetes (38%), smoking history (59%), and ejection fraction <40% (19%). The rate of PCI per month was equally distributed throughout the first year after CABG. 45% of patients had elective PCI for recurrence of symptoms while the remaining 55% had PCI on an urgent basis, 3% with acute ST-elevation myocardial infarction, and 1% in cardiogenic shock. PCI most often occurred in native coronary arteries (80%), usually following graft failure in a previously grafted vessel. Of graft PCIs, 87% occurred in venous and 13% in arterial conduits. PCI was successful in 94% of cases. The rate of in-hospital major adverse cardiovascular events (death, MI or stroke) was 1.9%. The rate of major bleeding was 1.9%. Conclusions: Patients requiring PCI within 1 year of CABG are more likely to present for repeat PCI on an urgent basis. Most PCI procedures in this cohort are performed in native coronary vessels that were originally grafted. Further studies are needed to determine whether the use of hybrid revascularization strategies (combination CABG and planned PCI) in appropriate vessels could reduce the need for urgent PCI within the first year after CABG.