ACC 2020 — CTO PCI: previous CABG tied to worse outcomes


  • Pavankumar Kamat
  • Conference Reports
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Takeaway

  • Percutaneous coronary intervention (PCI) of a vessel with chronic total occlusion (CTO) is associated with worse outcomes in patients who have undergone previous coronary artery bypass graft (CABG) surgery than those who have not.

Why this matters

  • CABG is associated with accelerated atherosclerosis proximal to the bypass graft touchdown.
  • CTO occurs in up to 46% of bypassed native arteries and is often difficult to treat.

Study design

  • Meta-analysis of 4 observational studies, including 8131 patients (with 8544 lesions), 2163 of whom had undergone previous CABG and the remaining had not.
  • Funding: No external funding.

Key results

  • In-hospital outcomes after CTO-PCI were significantly worse in patients with vs without previous CABG:
    • Mortality (OR, 2.8; 95% CI, 1.4-5.4).
    • Coronary perforation (OR, 2.1; 95% CI, 1.5-2.9).
    • Myocardial infarction (OR, 2.5; 95% CI, 1.5-4.2).
  • Incidence rates for acute cerebrovascular events and vascular complications were comparable between both groups.
  • Patients with previous CABG had a lower incidence of cardiac tamponade (OR, 0.19; 95% CI, 0.04-0.9).

Limitations

  • Patients with previous CABG were older and had more complex lesions. 

Expert commentary
Senior author, Dr Emmanouil S. Brilakis, MD, PhD, from the Minneapolis Heart Institute, said: "So for those patients, PCI should be done at an experienced center, because they are also more likely to require an advanced technique, like the retrograde approach."