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Repeat CABG demonstrates better long-term results than PCI in patients with previous revascularization

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NEW ORLEANS — Although patients who underwent a second CABG had an increased 30-day mortality compared with individuals who underwent PCI, overall survival and 10-year survival rates were greater in patients who underwent repeat CABG, according to findings presented at the American Heart Association Scientific Sessions.

Lawrence E. Greiten, MD, a cardiovascular and general thoracic resident at the Mayo Clinic in Rochester, Minn., and colleagues analyzed mortality and survival rates of 3,058 patients who underwent revascularization after previously undergoing CABG from 1993 to 2009.

Patients who underwent repeat CABG (n = 530) were divided into subgroups of individuals who received either arterial grafts (n = 396) or saphenous vein grafts (n = 134).

Patients undergoing PCI (n = 2,528) were also divided into subgroups. Patients either received balloon angioplasty (n = 491), bare mental stent (n = 1,267) or drug-eluting stent (n = 769). The researchers further stratified patients within the PCI group by the treated target into native coronary artery (n = 1,637), bypass grafts (n = 674), or both (n = 216).

In a multivariate analysis, patients undergoing repeat CABG had an increased 30-day mortality compared with individuals undergoing PCI (HR = 3.92; 95% CI, 2.25-6.84).

However, in a propensity-matched analysis (n = 287), there was not a significant difference in 30-day mortality between the two treatment arms (P = .09).

Overall survival was greater in patients who underwent repeat CABG in the multivariate analysis (HR = .7; 95% CI, 0.59-0.83). Ten-year survival was also greater in patients undergoing repeat CABG (52% vs. 37%).

Compared with repeat CABG, PCI involving bypass grafts demonstrated an increased risk for mortality (HR = 1.39; 95% CI, 1.09-1.78). PCI targeting the native coronaries did not increase mortality risks (HR = 1.12; 95% CI, 0.85-1.47).

Sixty percent of patients received an internal mammary artery graft at repeat CABG. Patients who underwent previous CABG and who had an internal mammary artery graft demonstrated improved survival (HR = 0.82; 95% CI, 0.72-0.92).

“We have shown that long-term survival is increased in CABG compared with PCI,” Greiten said during the presentation. “We also demonstrated an increase in mortality in PCI involving bypass grafts vs. PCI involving native coronary arteries, [and] have shown that the use of the IMA in previous CABG or in repeat CABG conferred a significant long-term survival. We feel that repeat CABG can safely be performed with excellent long-term outcomes.” – by Ryan McDonald

Reference:

Greiten LE, et al. IN.AOS.848 - Basic Science and Clinical Innovations in Heart Surgery. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Disclosure: The researchers report no relevant financial disclosures.