Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization

Chaim Locker, Lawrence E. Greiten, Malcolm R. Bell, Robert L. Frye, Amir Lerman, Richard C. Daly, Kevin L. Greason, Sameh M. Said, Brian D. Lahr, John M. Stulak, Joseph A. Dearani, Hartzell V Schaff

Research output: Contribution to journalArticle

Abstract

Objective: To assess long-term survival with repeat coronary artery bypass grafting (RCABG) or percutaneous coronary intervention (PCI) in patients with previous CABG. Methods: From January 1, 2000, through December 31, 2013, 1612 Mayo Clinic patients underwent RCABG (n=215) or PCI (n=1397) after previous CABG. The RCABG cohort was grouped by use of saphenous vein grafts only (n=75), or with additional arterial grafts (n=140); the PCI cohort by, bare metal stents (BMS; n=628), or drug-eluting stents (DES; n=769), and by the treated target into native coronary artery (n=943), bypass grafts only (n=338), or both (n=116). Multivariable regression and propensity score analysis (n=280 matched patients) were used. Results: In multivariable analysis, the 30-day mortality was increased in RCABG versus PCI patients (hazard ratio [HR], 5.32; 95%CI, 2.34-12.08; P<.001), but overall survival after 30 days improved with RCABG (HR, 0.72; 95% CI, 0.55-0.94; P=.01). Internal mammary arteries were used in 61% (129 of 215) of previous CABG patients and improved survival (HR, 0.82; 95% CI, 0.69-0.98; P=.03). Patients treated with drug-eluting stent had better 10-year survival (HR, 0.74; 95% CI, 0.59-0.91; P=.001) than those with bare metal stent alone. In matched patients, RCABG had improved late survival over PCI: 48% vs 33% (HR, 0.57; 95% CI, 0.35-0.91; P=.02). Compared with RCABG, patients with PCI involving bypass grafts (n=60) had increased late mortality (HR, 1.62; 95% CI, 1.10-2.37; P=.01), whereas those having PCI of native coronary arteries (n=80) did not (HR, 1.09; 95% CI, 0.75-1.59; P=.65). Conclusion: RCABG is associated with improved long-term survival after previous CABG, especially compared with PCI involving bypass grafts.

Original languageEnglish (US)
Pages (from-to)1743-1752
Number of pages10
JournalMayo Clinic proceedings
Volume94
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Percutaneous Coronary Intervention
Coronary Artery Bypass
Survival
Transplants
Drug-Eluting Stents
Stents
Coronary Vessels
Metals
Propensity Score
Mammary Arteries
Mortality
Saphenous Vein

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization. / Locker, Chaim; Greiten, Lawrence E.; Bell, Malcolm R.; Frye, Robert L.; Lerman, Amir; Daly, Richard C.; Greason, Kevin L.; Said, Sameh M.; Lahr, Brian D.; Stulak, John M.; Dearani, Joseph A.; Schaff, Hartzell V.

In: Mayo Clinic proceedings, Vol. 94, No. 9, 01.09.2019, p. 1743-1752.

Research output: Contribution to journalArticle

Locker, C, Greiten, LE, Bell, MR, Frye, RL, Lerman, A, Daly, RC, Greason, KL, Said, SM, Lahr, BD, Stulak, JM, Dearani, JA & Schaff, HV 2019, 'Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization', Mayo Clinic proceedings, vol. 94, no. 9, pp. 1743-1752. https://doi.org/10.1016/j.mayocp.2019.01.048
Locker, Chaim ; Greiten, Lawrence E. ; Bell, Malcolm R. ; Frye, Robert L. ; Lerman, Amir ; Daly, Richard C. ; Greason, Kevin L. ; Said, Sameh M. ; Lahr, Brian D. ; Stulak, John M. ; Dearani, Joseph A. ; Schaff, Hartzell V. / Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization. In: Mayo Clinic proceedings. 2019 ; Vol. 94, No. 9. pp. 1743-1752.
@article{c4a82d8239924cb8b3dcd01481818765,
title = "Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization",
abstract = "Objective: To assess long-term survival with repeat coronary artery bypass grafting (RCABG) or percutaneous coronary intervention (PCI) in patients with previous CABG. Methods: From January 1, 2000, through December 31, 2013, 1612 Mayo Clinic patients underwent RCABG (n=215) or PCI (n=1397) after previous CABG. The RCABG cohort was grouped by use of saphenous vein grafts only (n=75), or with additional arterial grafts (n=140); the PCI cohort by, bare metal stents (BMS; n=628), or drug-eluting stents (DES; n=769), and by the treated target into native coronary artery (n=943), bypass grafts only (n=338), or both (n=116). Multivariable regression and propensity score analysis (n=280 matched patients) were used. Results: In multivariable analysis, the 30-day mortality was increased in RCABG versus PCI patients (hazard ratio [HR], 5.32; 95{\%}CI, 2.34-12.08; P<.001), but overall survival after 30 days improved with RCABG (HR, 0.72; 95{\%} CI, 0.55-0.94; P=.01). Internal mammary arteries were used in 61{\%} (129 of 215) of previous CABG patients and improved survival (HR, 0.82; 95{\%} CI, 0.69-0.98; P=.03). Patients treated with drug-eluting stent had better 10-year survival (HR, 0.74; 95{\%} CI, 0.59-0.91; P=.001) than those with bare metal stent alone. In matched patients, RCABG had improved late survival over PCI: 48{\%} vs 33{\%} (HR, 0.57; 95{\%} CI, 0.35-0.91; P=.02). Compared with RCABG, patients with PCI involving bypass grafts (n=60) had increased late mortality (HR, 1.62; 95{\%} CI, 1.10-2.37; P=.01), whereas those having PCI of native coronary arteries (n=80) did not (HR, 1.09; 95{\%} CI, 0.75-1.59; P=.65). Conclusion: RCABG is associated with improved long-term survival after previous CABG, especially compared with PCI involving bypass grafts.",
author = "Chaim Locker and Greiten, {Lawrence E.} and Bell, {Malcolm R.} and Frye, {Robert L.} and Amir Lerman and Daly, {Richard C.} and Greason, {Kevin L.} and Said, {Sameh M.} and Lahr, {Brian D.} and Stulak, {John M.} and Dearani, {Joseph A.} and Schaff, {Hartzell V}",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.mayocp.2019.01.048",
language = "English (US)",
volume = "94",
pages = "1743--1752",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "9",

}

TY - JOUR

T1 - Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization

AU - Locker, Chaim

AU - Greiten, Lawrence E.

AU - Bell, Malcolm R.

AU - Frye, Robert L.

AU - Lerman, Amir

AU - Daly, Richard C.

AU - Greason, Kevin L.

AU - Said, Sameh M.

AU - Lahr, Brian D.

AU - Stulak, John M.

AU - Dearani, Joseph A.

AU - Schaff, Hartzell V

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: To assess long-term survival with repeat coronary artery bypass grafting (RCABG) or percutaneous coronary intervention (PCI) in patients with previous CABG. Methods: From January 1, 2000, through December 31, 2013, 1612 Mayo Clinic patients underwent RCABG (n=215) or PCI (n=1397) after previous CABG. The RCABG cohort was grouped by use of saphenous vein grafts only (n=75), or with additional arterial grafts (n=140); the PCI cohort by, bare metal stents (BMS; n=628), or drug-eluting stents (DES; n=769), and by the treated target into native coronary artery (n=943), bypass grafts only (n=338), or both (n=116). Multivariable regression and propensity score analysis (n=280 matched patients) were used. Results: In multivariable analysis, the 30-day mortality was increased in RCABG versus PCI patients (hazard ratio [HR], 5.32; 95%CI, 2.34-12.08; P<.001), but overall survival after 30 days improved with RCABG (HR, 0.72; 95% CI, 0.55-0.94; P=.01). Internal mammary arteries were used in 61% (129 of 215) of previous CABG patients and improved survival (HR, 0.82; 95% CI, 0.69-0.98; P=.03). Patients treated with drug-eluting stent had better 10-year survival (HR, 0.74; 95% CI, 0.59-0.91; P=.001) than those with bare metal stent alone. In matched patients, RCABG had improved late survival over PCI: 48% vs 33% (HR, 0.57; 95% CI, 0.35-0.91; P=.02). Compared with RCABG, patients with PCI involving bypass grafts (n=60) had increased late mortality (HR, 1.62; 95% CI, 1.10-2.37; P=.01), whereas those having PCI of native coronary arteries (n=80) did not (HR, 1.09; 95% CI, 0.75-1.59; P=.65). Conclusion: RCABG is associated with improved long-term survival after previous CABG, especially compared with PCI involving bypass grafts.

AB - Objective: To assess long-term survival with repeat coronary artery bypass grafting (RCABG) or percutaneous coronary intervention (PCI) in patients with previous CABG. Methods: From January 1, 2000, through December 31, 2013, 1612 Mayo Clinic patients underwent RCABG (n=215) or PCI (n=1397) after previous CABG. The RCABG cohort was grouped by use of saphenous vein grafts only (n=75), or with additional arterial grafts (n=140); the PCI cohort by, bare metal stents (BMS; n=628), or drug-eluting stents (DES; n=769), and by the treated target into native coronary artery (n=943), bypass grafts only (n=338), or both (n=116). Multivariable regression and propensity score analysis (n=280 matched patients) were used. Results: In multivariable analysis, the 30-day mortality was increased in RCABG versus PCI patients (hazard ratio [HR], 5.32; 95%CI, 2.34-12.08; P<.001), but overall survival after 30 days improved with RCABG (HR, 0.72; 95% CI, 0.55-0.94; P=.01). Internal mammary arteries were used in 61% (129 of 215) of previous CABG patients and improved survival (HR, 0.82; 95% CI, 0.69-0.98; P=.03). Patients treated with drug-eluting stent had better 10-year survival (HR, 0.74; 95% CI, 0.59-0.91; P=.001) than those with bare metal stent alone. In matched patients, RCABG had improved late survival over PCI: 48% vs 33% (HR, 0.57; 95% CI, 0.35-0.91; P=.02). Compared with RCABG, patients with PCI involving bypass grafts (n=60) had increased late mortality (HR, 1.62; 95% CI, 1.10-2.37; P=.01), whereas those having PCI of native coronary arteries (n=80) did not (HR, 1.09; 95% CI, 0.75-1.59; P=.65). Conclusion: RCABG is associated with improved long-term survival after previous CABG, especially compared with PCI involving bypass grafts.

UR - http://www.scopus.com/inward/record.url?scp=85071482760&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071482760&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2019.01.048

DO - 10.1016/j.mayocp.2019.01.048

M3 - Article

C2 - 31486379

AN - SCOPUS:85071482760

VL - 94

SP - 1743

EP - 1752

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 9

ER -