Impact of previous coronary artery bypass surgery on clinical outcome after percutaneous interventions with second generation drug-eluting stents in TWENTE trial and Non-Enrolled TWENTE registry

BackgroundPatients with previous coronary artery bypass grafting (CABG) who underwent percutaneous coronary intervention (PCI) have an increased repeat revascularization rate, but data on contemporary second-generation drug-eluting stents (DES) are scarce.MethodsWe evaluated 1-year clinical outcome following secondary revascularization by PCI in patients of the TWENTE trial and non-enrolled TWENTE registry, and compared patients with previous CABG versus patients without previous CABG.ResultsOf all 1709 consecutive patients, 202 (11.8%) had previously undergone CABG (on average 11.2 ± 8.5 years ago). CABG patients were older (68.5 ± 9.4 years vs. 64.1 ± 10.7 years, P < 0.001) and more often had diabetes (28.7% vs. 20.9%, P = 0.01) and previous PCI (40.1% vs. 19.8%, P < 0.001) compared to patients without previous CABG. Nevertheless, a higher target vessel revascularization (TVR) rate following PCI in the CABG patients (9.4% vs. 2.3%, P < 0.001) was the only significant difference in clinical outcome at 1-year follow-up (available for 99.6%). Among CABG patients, the TVR rate was significantly higher in patients treated for graft lesions (n = 65; 95.4% in vein grafts) than in patients treated for native coronary lesions only (n = 137) (18.5% vs. 5.1%, P = 0.002). Among 1638 patients with PCI of native coronary lesions only, there was only a non-significant difference in TVR between patients with previous CABG versus patients without previous CABG (5.1% vs. 2.3%, P = 0.08).ConclusionsPatients with previous CABG showed a favorable safety profile after PCI with second-generation DES. Nevertheless, their TVR rate was still much higher, driven by more repeat revascularizations after PCI of degenerated vein grafts. In native coronary lesions, there was no such difference.