| Background: Percutaneous coronary intervention(PCI)is a common method of revascularization after coronary artery bypass graft(CABG).However,controversies exist about the selection of native vessel or bypass graft PCI.Objective: To analyze the outcomes of PCI strategies for repeated revascularization patients with the history of CABG in Dalian,and to perform a meta-analysis on the outcomes of PCI in native vessels versus bypass graft in prior CABG patients.Methods: 1.From September 23 st 2002 to August 15 th 2017,34 consecutive patients with a history of CABG who underwent PCI in native coronary arteries or/and bypass grafts in two tertiary hospitals of Dalian.Baseline clinical,angiographic characteristics,PCI strategies,in-hospital drug treatment,in-hospital all-cause mortality and main adverse cardiac events(MACE)were collected and recorded prospectively.Follow-up information was available via telephone interview,and documentation of outpatient review on the hospital local databases.The all-cause mortality,MACE and recurring angina pectoris were followed up.Especially,MACE included cardiac death,nonfatal MI,and unplanned repeated revascularization.2.12 cohort studies that compared the outcomes of native coronary artery PCI with bypass graft PCI in prior CABG patients were published.The clinical endpoint data were analyzed using fixed-effects models if I2 statistic was <50%,or random-effects models for I2>50%.Results: 1.(1)Baseline data: A total of 34 patients(mean age: 67.2±7.9 years),including 27 males(79.4%)and 7 females(20.6%)were collected.Coronary heart disease risk factors: hypertension(76.5%),diabetes(32.4%)and smoking(32.4%).Disease history: cerebrovascular disease(14.7%),heart failure(44.1%),myocardial infarction(17.6%),and PCI before CABG(20.6%).After the onset,97.1% of the patients mainly complained of chest pain or/and chest tightness,while 2.9% complained of other symptoms.Presentation symptoms: 30 patients(88.2%)with unstable angina and 4(11.8%)with acute myocardial infarction(MI).(2)Revascularization characteristics: The duration from CABG to PCI was 67.3 ± 46.5months.The average number of bypass grafts were 2.9 ± 1.2 months.PCI approach: 4patients(11.8%)via radial artery approach and 30 patients(88.2%)via femoral artery.Nobody used IABP.1 patient(2.9%)used temporary pacemaker.During PCI procedure,1 patient(2.9%)received bivalirudin infusion,33 patients(97.1%)used unfractionated heparin,and 4 patients(11.8%)were treated with glyco-protein IIb/IIIa(GPⅡb/Ⅲa)inhibitors.The location of lesions: 12 patients(35.3%)with native lesions,16 patients(47.1%)with native and bypass vessels lesions including 10(29.4%)with vein bypass grafts,3(8.8%)with artery bypass grafts and 3(8.8%)with both of vein and artery bypass grafts.Additionally,the location of lesions were uncertain in 6 patients(17.6%).PCI strategies: 22 patients(61.8%)received native PCI,1(2.9%)received native and bypass graft PCI,4(11.8%)received bypass graft PCI.The PCI strategy was uncertain in 4 patients(11.8%).During the hospitalization,the average number of implanted stent was 1.7 ± 0.9,with the mean stent length of 41.4±25.9 mm,the minimum diameter of3.2±0.8mm,and the maximum diameter of 3.6±0.7mm.(3)In-hospital drug treatment and mean hospital stay: Low molecular weight heparin(55.9%),GPⅡb/Ⅲa inhibitors(26.5%),aspirin(76.5%),clopidogrel/ticagrelor(82.4%),statin(70.6%,β-blockers(73.5%),ACEI/ARB(61.8%)and calcium channel blockers(29.4%).Mean hospital stay: 11.7±5.3 days.(4)No PCI patients with the history of CABG died and/or developed MACE during hospitalization.(5)Long term-prognosis: The patients were followed up for 4.5 years(range: 2.8-8.0years).The total all-cause mortality was 8.8%(3 patients),all of whom died of heart disease.The total incidence of MACE was 41.2%(14 patients).The total rate of recurrent angina pectoris was 61.8%(21 patients).There were no significant differences between native PCI and bypass graft PCI(all-cause mortality 9.5% vs.12.5%,P= 0.46;risks of MACE 42.9% vs.50.0%,P=0.30;rates of recurrent angina pectoris 66.7% vs.75.0%,P=0.26).2.Results of meta-analysis: Compared with bypass graft PCI,native PCI after CABG had a lower risk of in-hospital mortality(relative risk: 0.522;95% confidence interval[CI]: 0.366–0.743;P< 0.001),lower long-term all-cause mortality(hazard ratio [HR]:0.766;95% CI: 0.698–0.840;P< 0.001),and lower risk of MI(HR: 0.621;95% CI:0.551–0.699;P< 0.001)and MACE(HR: 0.426;95% CI: 0.308–0.590;P< 0.001).Conclusion: 1.There are more males than females of PCI patients with the CABG history in Dalian,and most received native PCI.The short-term outcomes of both native PCI and bypass graft PCI are satisfactory.During the follow-up,the native PCI is associated with lower all-cause mortality,risk of MACE and the rate of recurrent angina pectoris than bypass graft PCI.2.According to the meta-analysis: Compared with bypass graft PCI,native PCI after CABG is associated with reduced long-term all-cause mortality,and lower risk of MI and MACE.Further studies are needed to clarify whether native PCI can reduce the rate of in-hospital mortality. |
