Percutaneous Coronary Intervention Superior in Some Post–Coronary Bypass Graft Patients

Percutaneous coronary intervention (PCI) may be preferable to repeat coronary artery bypass graft (CABG) for many CABG patients.

This is the conclusion of clinicians at the Veterans Administration Medical Center and the University of Arizona, Tucson, Arizona, in a comparative study of long-term survival of post-CABG patients who subsequently underwent either PCI or repeat CABG. The post-CABG patients were drawn from the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) randomised trial as well as a prospective registry of patients who underwent CABG and needed additional treatment.

Included in the cohort of 454 patients in the AWESOME trial were 142 who had prior CABG. Among 1,650 patients in the physician-directed registry, 719 had prior CABG, and of the 327 patient-choice registry patients, 119 had at least one prior CABG.

The investigators found no statistical difference in three-year survival from the AWESOME trial, with 73 percent survival for the 75 repeat CABG patients and 76 percent for the 67 PCI patients. Similarly, in the physician-directed registry, three-year survival was 71 percent for patients who had repeat CABG and 77 percent for those who had PCI, which was not statistically different.

However, in the patient-choice registry, three-year survival was 65 percent for the 32 patients who had repeat surgery and 86 percent for those who had PCI.

Because repeat CABG surgery is associated with a higher risk of mortality than first-time CABG, the clinicians conclude that PCI may be preferable to CABG for many post-CABG patients.

J Am Coll Cardiol 2002;40(11):1951-4