Coronary artery bypass grafting outcomes in patients with prior percutaneous coronary intervention: A retrospective cohort study.

Abstract

Objective: The clinical significance of prior percutaneous coronary intervention (PCI) in patients undergoing coronary artery bypass grafting (CABG) remains debated, particularly regarding long-term mortality, need for repeat revascularization, and the prognostic value of intraoperative graft flow.

Methods: In this single-center retrospective cohort study, 3,591 patients who underwent isolated CABG between 2005 and 2023 were analyzed and stratified by prior PCI status. Baseline, surgical, and follow-up data were collected, with multivariable regression and interaction analyses performed to investigate associations between prior PCI, reintervention, mortality, and intraoperative graft flow.

Results: Prior PCI was not associated with increased mortality after adjustment for clinical and procedural variables (HR 1.00, 95%CI 0.861-1.160, p > 0.99), but independently predicted higher rates of repeat coronary reintervention (HR 1.553, 95%CI 1.225-1.969, p < 0.001), especially for recent and urgent PCI (HR 2.304, 95%CI 1.141-4.651, p = 0.020). The prognostic effect of prior PCI was heterogeneous, with adverse outcomes more closely associated in unfavourable coronary anatomy. Importantly, intraoperative graft flow to the right coronary artery was predictive for adverse events only in patients with prior PCI (Interaction p = 0.002; HR 0.424, 95%CI 0.244-0.738 per log2-increment in RCA graft flow within the prior-PCI stratum).

Conclusion: Prior PCI was not independently associated with increased mortality after CABG but is a predictor of repeat revascularization. The effect is heterogeneous and most pronounced among patients with additional risk factors and reduced right coronary graft flow. These findings underscore the need for individualized risk assessment and tailored perioperative management in CABG patients with a history of PCI.