Impact of Prior Percutaneous Coronary Intervention Lesions on Long-term Outcomes after Coronary Artery Bypass Grafting: An Analysis over Two Decades

G. Yamashita¹, J. Sakai², T. Takauchi¹, S. Otani¹, S. Nakano¹, R. Fujimoto¹, A. Sugaya¹, S. Hirao¹, T. Komiya^1
1Kurashiki central hospital, Kurashiki, Okayama ²Kyoto University Hospital, Kurashiki, Okayama

Purpose: Previous studies have reported long-term outcomes after coronary artery bypass grafting (CABG) based on the frequency of prior percutaneous coronary intervention (PCI). However, the impact of the number of PCI-treated coronary lesions on long-term clinical outcomes after CABG remains unexplored.

Methods: Between January 2000 and January 2024, among 2442 patients undergoing CABG at our institution, the study population consisted of 1165 patients, after excluding 903 patients with concomitant procedures, 334 with emergent operations, and 40 with single-vessel bypass. Coronary lesions were categorized into three main regions: left anterior descending, left circumflex , and right coronary artery. Patients were grouped based on prior PCI lesions into three categories: no prior PCI (n=729), single-lesion PCI (n=217), and multiple-lesion PCI (n=219). In-hospital outcomes, including mortality and postoperative complications, were compared between the groups. Long-term outcomes were assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards models, adjusting for 26 clinically relevant factors.

Results: Maximum follow-up was 24.2 years, with a median follow-up of 8.4 years (interquartile range, 4.2-12.9). Stent types in prior PCI were distributed as follows: bare-metal stents 25.3% (n=295), first-generation drug-eluting stents 9.3% (n=108), second-generation or newer drug-eluting stents 7.7% (n=90), and drug-coated balloons 1.5% (n=17). Regarding in-hospital outcomes, the incidence of acute kidney injury was significantly higher in the multiple-lesion PCI group compared to the no prior PCI and single-lesion PCI groups (24.8% versus 22.1% versus 34.2%, P=0.008). Long-term follow-up analysis revealed significantly lower 15-year survival rates in the multiple-lesion PCI group (35.4%) compared to no PCI (48.2%) and single-lesion PCI (47.7%) groups (log-rank P=0.002) (Figure). After adjusting for confounders, the risk of the multiple-lesion PCI group relative to the no prior PCI group was numerically higher for all-cause death (HR: 1.24; 95％ CI: 0.99-1.56; P=0.064), and significantly higher for cardiac death, myocardial infarction, heart failure hospitalization and repeat revascularization(HR: 1.89; 95％ CI: 1.21-2.93; P=0.005; HR: 2.82; 95％ CI: 1.26-6.31; P=0.012; HR: 1.99; 95％ CI: 1.27-3.14; P=0.003, and HR: 2.10; 95％ CI: 1.43-3.07; P< 0.001) (Table). No significant differences were found between the single-lesion PCI and no prior PCI groups for any of these outcomes.

Conclusion: While in-hospital mortality was similar across the groups, patients with prior multiple-lesion PCI had higher rates of acute kidney injury. Prior multiple-lesion PCI was associated with higher long-term risk for cardiac death, myocardial infarction, heart failure hospitalization, and repeat revascularization after CABG. These findings underscore the need for careful risk assessment and tailored management strategies in patients with extensive PCI history undergoing CABG.

Identify the source of the funding for this research project: This research received no specific funding