Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients with Prior Coronary Artery Bypass Graft Surgery Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Emmanouil S. Brilakis, Colin I. O'Donnell, William Penny, Ehrin J. Armstrong, Thomas Tsai, Thomas M. Maddox, Mary E. Plomondon, Subhash Banerjee, Sunil V. Rao, Santiago Garcia, Brahmajee Nallamothu, Kendrick A. Shunk, Kreton Mavromatis, Gary K. Grunwald, Deepak L. Bhatt

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. Background Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. Methods A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). Results During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). Conclusions In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)884-893
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume9
Issue number9
DOIs
StatePublished - May 9 2016
Externally publishedYes

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Veterans
Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Coronary Vessels
Confidence Intervals
Integrated Delivery of Health Care
Veterans Hospitals
Saphenous Vein
Hospital Mortality
Logistic Models
Myocardial Infarction

Keywords

  • bypass graft
  • coronary bypass graft surgery
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients with Prior Coronary Artery Bypass Graft Surgery Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. / Brilakis, Emmanouil S.; O'Donnell, Colin I.; Penny, William; Armstrong, Ehrin J.; Tsai, Thomas; Maddox, Thomas M.; Plomondon, Mary E.; Banerjee, Subhash; Rao, Sunil V.; Garcia, Santiago; Nallamothu, Brahmajee; Shunk, Kendrick A.; Mavromatis, Kreton; Grunwald, Gary K.; Bhatt, Deepak L.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 9, 09.05.2016, p. 884-893.

Research output: Contribution to journalArticle

Brilakis, ES, O'Donnell, CI, Penny, W, Armstrong, EJ, Tsai, T, Maddox, TM, Plomondon, ME, Banerjee, S, Rao, SV, Garcia, S, Nallamothu, B, Shunk, KA, Mavromatis, K, Grunwald, GK & Bhatt, DL 2016, 'Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients with Prior Coronary Artery Bypass Graft Surgery Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program', JACC: Cardiovascular Interventions, vol. 9, no. 9, pp. 884-893. https://doi.org/10.1016/j.jcin.2016.01.034
Brilakis, Emmanouil S. ; O'Donnell, Colin I. ; Penny, William ; Armstrong, Ehrin J. ; Tsai, Thomas ; Maddox, Thomas M. ; Plomondon, Mary E. ; Banerjee, Subhash ; Rao, Sunil V. ; Garcia, Santiago ; Nallamothu, Brahmajee ; Shunk, Kendrick A. ; Mavromatis, Kreton ; Grunwald, Gary K. ; Bhatt, Deepak L. / Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients with Prior Coronary Artery Bypass Graft Surgery Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 9. pp. 884-893.
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abstract = "Objectives The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. Background Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. Methods A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). Results During the study period, patients with prior CABG represented 18.5{\%} of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4{\%} and a bypass graft in 26.6{\%}: 25.0{\%} in a saphenous vein graft and 1.5{\%} in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95{\%} confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95{\%} confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95{\%} confidence interval: 1.50 to 1.71). Conclusions In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.",
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T1 - Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients with Prior Coronary Artery Bypass Graft Surgery Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

AU - Brilakis, Emmanouil S.

AU - O'Donnell, Colin I.

AU - Penny, William

AU - Armstrong, Ehrin J.

AU - Tsai, Thomas

AU - Maddox, Thomas M.

AU - Plomondon, Mary E.

AU - Banerjee, Subhash

AU - Rao, Sunil V.

AU - Garcia, Santiago

AU - Nallamothu, Brahmajee

AU - Shunk, Kendrick A.

AU - Mavromatis, Kreton

AU - Grunwald, Gary K.

AU - Bhatt, Deepak L.

PY - 2016/5/9

Y1 - 2016/5/9

N2 - Objectives The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. Background Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. Methods A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). Results During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). Conclusions In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.

AB - Objectives The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. Background Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. Methods A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). Results During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). Conclusions In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.

KW - bypass graft

KW - coronary bypass graft surgery

KW - percutaneous coronary intervention

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