Rescue percutaneous coronary intervention following coronary artery bypass graft—A descriptive analysis of the changing interface between interventional cardiologist and cardiac surgeon

Abstract

SummaryBackground: Despite decreasing rates of acute and subacute complications of percutaneous coronary intervention (PCI), these procedures are generally only performed in centers where it is possible for failed PCI to be treated by rescue coronary artery bypass graft (CABG). Case reports and case series have documented successful PCI following failed CABG. We sought to confirm this decrease in the need for rescue CABG following failed PCI and to examine trends in the utilization of rescue PCI following failed CABG.Hypothesis: The interface between interventional cardiologist and cardiac surgeon is characterized by changing practice patterns and resource utilization.Methods: We examined the medical records of all patients admitted to the Brigham and Women's Hospital over a 7-year period and identified 169 patients who required both PCI and CABG during the same hospital admission. We describe and compare three predetermined groups of patients defined by the sequence of, and indication for, the relevant myocardial revascularization procedures.Results: In all, 100 patients required CABG for failed PCI, 46 patients had planned hybrid procedures involving both

Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure

“…ventricular arrhythmias and haemodynamic instability. 2,3,5 In the present study, myocardial ischaemia was again the predominant clinical presentation. Myocardial infarction was the leading ischaemic condition in the group of patients with pathological graft lesions and was significantly more common than in those with technical lesions.…”

“…8 Likewise, PCI with stenting of both the native arterial system and the coronary grafts has been successfully used to treat perioperative ischaemia. 3,13,14 The use of PCI in our case series has also yielded rewarding results. In concordance with the current interventional practice, PCI of native coronary vessels was the revascularisation method of choice when pathological graft lesions were found (p=0.08); conversely PCI of the culprit graft was usually the preferred interventional procedure when technical lesions were encountered.…”

“…[1][2][3] Furthermore, postoperative myocardial ischaemia has been linked to a decreased late survival. 2 Coronary angiography has proven to be safe and precise to confirm early graft failure.…”

“…[7][8][9][10][11][12][13] With the recent changes in coronary surgery practice and advances in percutaneous coronary intervention (PCI), these complications may have different trends, features and outcomes. 3,4 The purpose of this study was to determine the incidence, clinical features, and angiographic characteristics of early graft failure in the present CABG era, and to assess the impact of procedural performance on short-term outcomes in patients undergoing PCI after early graft failure.…”

Coronary artery revascularisation: selecting the appropriate strategy

“…3 This has allowed percutaneous coronary interventions to be performed with less attention to the availability of cardiac surgical support, thus improving patient access, particularly in rural and regional centres.…”