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Heart doi:10.1136/heartjnl-2013-303763
  • Coronary revascularisation
  • Original article

Impact of prior coronary artery bypass graft surgery on chronic total occlusion revascularisation: insights from a multicentre US registry

  1. David E Kandzari3
  1. 1Department of Internal Medicine/Cardiology, VA North Texas Healthcare System, Dallas, Texas, USA
  2. 2Department of Internal Medicine/Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  3. 3Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
  4. 4Department of Cardiology, St. Joseph Hospital, Bellingham, Washington, USA
  1. Correspondence to Dr Emmanouil S Brilakis, Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216, USA; esbrilakis{at}yahoo.com
  • Received 5 February 2013
  • Revised 18 March 2013
  • Accepted 19 March 2013
  • Published Online First 18 April 2013

Abstract

Objective To investigate the impact of prior coronary artery bypass graft (CABG) surgery on the outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).

Design Observational retrospective study.

Setting Three tertiary hospitals in the USA.

Participants 1363 consecutive patients who underwent CTO PCI between 2006 and 2011.

Main outcome measures Procedural success and inhospital complications, which were compared between patients with and without prior CABG.

Results Compared to patients without prior CABG, those with prior CABG were older, had more comorbidities, were treated more frequently with the retrograde approach (46.7% vs 27.1%, p<0.001) and had lower technical success rates (79.7% vs 88.3%, p=0.015). Of the 24 (1.8%) major inhospital complications, 11 occurred in patients with prior CABG and 13 in patients without prior CABG (2.1% vs 1.5%, p=0.392). In multivariable analysis prior CABG was independently associated with lower technical success rate (OR 0.49, 95% CIs 0.35 to 0.70, p<0.001).

Conclusions In a large multicentre registry, CTO PCI was frequently performed among patients with prior CABG, with higher use of the retrograde approach and similar complications but lower technical success rates compared to patients without prior CABG.

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