Long‐Term Outcome of Consecutive Patients With Previous Coronary Bypass Surgery, Treated With Newer‐Generation Drug‐Eluting Stents

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Frits H. A. F. de Man¹  K. Gert van Houwelingen¹  Paolo Zocca¹  Clemens von Birgelen¹  Marlies M. Kok¹  Marije M. Löwik¹  J. (Hans) W. Louwerenburg¹  Hanim Sen¹  Liefke C. van der Heijden¹  Marc Hartmann¹  Martin G. Stoel¹  Gerard C. M. Linssen²  Jan G. Grandjean³  Silvia Mariani³  Carine J. M. Doggen⁴ 

[1] Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands;Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands;Department of Cardiothoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands;Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands;

关键词: coronary artery bypass graft;    drug‐eluting stent;    percutaneous coronary intervention;    Resolute;    Xience V;   

DOI  :  10.1161/JAHA.117.007212

来源: DOAJ

【 摘 要 】

BackgroundPercutaneous coronary intervention (PCI) in patients with previous coronary artery bypass grafting (CABG) is associated with adverse clinical events. Although newer generation drug‐eluting stents showed favorable short‐term safety profiles, there is a lack of long‐term outcome data. We evaluated the impact of previous CABG on 5‐year clinical outcomes of patients treated with PCI using newer‐generation drug‐eluting stents. Methods and ResultsIn this patient‐level pooled analysis of the prospective TWENTE (The Real‐World Endeavor Resolute versus Xience V Drug‐Eluting Stent Study in Twente) trial and nonenrolled TWENTE registry, we assessed a consecutive series of patients who underwent PCI with newer‐generation drug‐eluting stents for non–ST‐segment–elevation acute coronary syndromes or stable angina. Of all 1709 patients, 202 (11.8%) had a history of CABG. Patients with previous CABG had significantly higher 5‐year rates of cardiac death (10.4% versus 4.3%; P<0.001) and target vessel revascularization (25.0% versus 8.1%; P<0.001). These differences remained statistically significant after adjustment for differences in baseline characteristics. Landmark analysis revealed that from 1‐ to 5‐year follow‐up, the rates of cardiac death (8.1% versus 3.2%; P<0.001) and target vessel revascularization (17.1% versus 5.9%; P<0.001) were significantly higher in patients with previous CABG. Among patients with a history of CABG, PCI of an obstructed vein graft was associated with a higher rate of 5‐year target vessel revascularization (P=0.003). ConclusionsAt 5‐year follow‐up after PCI with newer‐generation drug‐eluting stents, the risk of cardiac death and target vessel revascularization was significantly higher in patients with previous CABG. The target vessel revascularization rate was highest in patients who underwent PCI of obstructed vein grafts.

【 授权许可】

Unknown