Comparison of event and procedure rates following percutaneous transluminal coronary angioplasty in patients with and without previous coronary artery bypass graft surgery [the ROSETTA (Routine versus Selective Exercise Treadmill Testing after Angioplasty) Registry]

Percutaneous Revascularization of Grafts versus Native Coronary Arteries in Postcoronary Artery Bypass Graft Patients

In patients with previous coronary artery bypass graft surgery, it is unknown whether better results may be obtained with percutaneous interventions of grafts versus native arteries. The clinical outcomes in 84 patients undergoing percutaneous interventions of either grafts (n = 31) or native arteries (n = 53) were compared. Procedural success rate was 95.3% (96.8% in the graft group vs 94.4% in the native group, P = .3). Mean follow-up was 19 ± 7 months. The incidence of major adverse events was 14.2% (12.9% vs 15.1% in the graft and native groups, respectively; P = .8), mortality rate was 3.5% (6.4% vs 1.8% in the graft and native groups, respectively; P = .3), and target-lesion revascularization was performed in 4.7% (6.4% vs 3.7% in the graft and native groups, respectively, P = .6). In conclusion, both graft or native percutaneous interventions were similar for immediate and midterm clinical outcomes. The relatively low risk need for target-lesion revascularization obtained with both strategies is encouraging.

Percutaneous revascularization of grafts versus native coronary arteries in postcoronary artery bypass graft patients

In patients with previous coronary artery bypass graft surgery, it is unknown whether better results may be obtained with percutaneous interventions of grafts versus native arteries. The clinical outcomes in 84 patients undergoing percutaneous interventions of either grafts (n = 31) or native arteries (n = 53) were compared. Procedural success rate was 95.3% (96.8% in the graft group vs 94.4% in the native group, P = .3). Mean follow-up was 19 +/- 7 months. The incidence of major adverse events was 14.2% (12.9% vs 15.1% in the graft and native groups, respectively; P = .8), mortality rate was 3.5% (6.4% vs 1.8% in the graft and native groups, respectively; P = .3), and target-lesion revascularization was performed in 4.7% (6.4% vs 3.7% in the graft and native groups, respectively, P = .6). In conclusion, both graft or native percutaneous interventions were similar for immediate and midterm clinical outcomes. The relatively low risk need for target-lesion revascularization obtained with both strategies is encouraging.

Effectiveness of the sirolimus-eluting stent in the treatment of patients with a prior history of coronary artery bypass graft surgery

OBJECTIVE

Percutaneous coronary intervention in patients with a history of previous coronary artery bypass grafting (CABG) is associated with an increased rate of subsequent adverse events compared to those without prior CABG. We evaluated the impact of utilizing the sirolimus-eluting stent (SES) in this high-risk population.

METHODS

Since April 2002, SES implantation was utilized as the default strategy for all percutaneous procedures in our hospital. Consecutive patients with a history of previous CABG and de novo lesions (n=47) treated exclusively with SES, were compared to 66 patients who received bare stents in the 6-month period just before SES introduction.

RESULTS

There were no significant differences between the groups (SES and bare stent) with respect to baseline clinical or lesion characteristics. The only difference between the groups related to the nominal diameter of stent utilized, which was smaller in the SES group than the bare stent group. (The maximum diameter of SES available was 3.0 mm). At 1 year, the cumulative incidence of major adverse events (defined as death, myocardial infarction, or target vessel revascularization) was significantly lower in the SES group than the bare stent group [8.5 versus 30.3%, hazard ratio 0.37 (95% confidence interval 0.15-0.91); P=0.03].

CONCLUSIONS

The utilization of the sirolimus-eluting stent for percutaneous intervention in a high-risk population with a history of previous CABG surgery is associated with a significant reduction in the rate of major adverse cardiac events at 1 year.