Bifurcation percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Analysis from the PROGRESS-BIFURCATION registry.

BACKGROUND

Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG).

OBJECTIVES

We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG.

METHODS

We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024.

RESULTS

Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, p=0.942) and procedural (91.5% vs 91.1%, p=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, p = 0.031). Prior CABG patients had lower rates of side branch occlusion (SBO) after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, p = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, p = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, p = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes.

CONCLUSIONS

Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel.