Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis from the PROGRESS-BIFURCATION registry.
Dimitrios Strepkos, Michaella Alexandrou, Deniz Mutlu, Pedro E P Carvalho, Ozgur S Ser, Jaskanwal Deep Singh Sara, Oleg Krestyaninov, Dimitri Khelimskii, Barkin Kultursay, Ali Karagoz, Ufuk Yildirim, Korhan Soylu, Mahmut Uluganyan, Olga Mastrodemos, Bavana V Rangan, Sandeep Jalli, Konstantinos Voudris, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis
{"title":"Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis from the PROGRESS-BIFURCATION registry.","authors":"Dimitrios Strepkos, Michaella Alexandrou, Deniz Mutlu, Pedro E P Carvalho, Ozgur S Ser, Jaskanwal Deep Singh Sara, Oleg Krestyaninov, Dimitri Khelimskii, Barkin Kultursay, Ali Karagoz, Ufuk Yildirim, Korhan Soylu, Mahmut Uluganyan, Olga Mastrodemos, Bavana V Rangan, Sandeep Jalli, Konstantinos Voudris, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis","doi":"10.1016/j.carrev.2025.05.018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG).</p><p><strong>Objectives: </strong>We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.</p><p><strong>Methods: </strong>We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024.</p><p><strong>Results: </strong>Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, p=0.942) and procedural (91.5% vs 91.1%, p=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, p = 0.031). Prior CABG patients had lower rates of side branch occlusion after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, p = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, p = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, p = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes.</p><p><strong>Conclusions: </strong>Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Revascularization Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.carrev.2025.05.018","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG).
Objectives: We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.
Methods: We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024.
Results: Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, p=0.942) and procedural (91.5% vs 91.1%, p=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, p = 0.031). Prior CABG patients had lower rates of side branch occlusion after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, p = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, p = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, p = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes.
Conclusions: Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel.
背景：分叉经皮冠状动脉介入治疗（PCI）在既往冠状动脉搭桥手术（CABG）患者中的应用研究尚不充分。目的：我们试图评估有CABG和没有CABG的患者的临床和程序特征以及分岔PCI的结果。方法：我们比较了2014年至2024年间在5个中心接受了1496例分岔pci的1305例CABG患者的技术、程序特征和预后。结果：既往CABG患者占研究人群的14.4%，年龄较大，心血管危险因素较多，血管造影复杂性较高，包括中度或重度主血管近端扭曲和钙化的发生率较高。技术成功率（95.0% vs 94.8%, p=0.942）和手术成功率（91.5% vs 91.1%, p=0.875）在有和没有CABG的患者中相似；先前CABG患者使用临时支架的频率较低（60.6% vs 68.0%, p = 0.031）。在调整混杂因素后，既往CABG患者侧支闭塞率较低（调整优势比[OR]: 0.27, 95%可信区间[CI]: 0.08, 0.72, p = 0.018），院内类似的主要不良心血管事件（3.7% vs 4.1%, p = 0.800）。在中位随访1095天期间，既往CABG患者靶血管重建术发生率较高（校正风险比[HR]: 1.71, 95% CI: 1.01, 2.89, p = 0.004）。在既往冠脉搭桥的患者中，接受PCI的患者冠状动脉解剖结构更复杂，但技术上的成功和短期和长期的结果相似。结论：既往CABG患者行分岔PCI术后发生SBO的风险较低，随访TVR较高。在先前的CABG患者中，介入搭桥术的住院和随访结果与自体血管介入相似。
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
