Hanim Sen1, Ming Kai Lam1, Kenneth Tandjung1, Marije M Löwik1, K Gert van Houwelingen1, Martin G Stoel1, Hans W Louwerenburg1, Frits H A F de Man1, Gerard C M Linssen2, Jan G Grandjean3, Carine J M Doggen4, Clemens von Birgelen5. 1. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands. 2. Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands. 3. Department of Cardiothoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands. 4. Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. 5. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. Electronic address: c.vonbirgelen@mst.nl.
Abstract
BACKGROUND:Patients with previous coronary artery bypass grafting (CABG) who underwentpercutaneous coronary intervention (PCI) have an increased repeat revascularization rate, but data on contemporary second-generation drug-eluting stents (DES) are scarce. METHODS: We evaluated 1-year clinical outcome following secondary revascularization by PCI in patients of the TWENTE trial and non-enrolled TWENTE registry, and compared patients with previous CABG versus patients without previous CABG. RESULTS: Of all 1709 consecutive patients, 202 (11.8%) had previously undergone CABG (on average 11.2±8.5 years ago). CABG patients were older (68.5±9.4 years vs. 64.1±10.7 years, P<0.001) and more often had diabetes (28.7% vs. 20.9%, P=0.01) and previous PCI (40.1% vs. 19.8%, P<0.001) compared to patients without previous CABG. Nevertheless, a higher target vessel revascularization (TVR) rate following PCI in the CABG patients (9.4% vs. 2.3%, P<0.001) was the only significant difference in clinical outcome at 1-year follow-up (available for 99.6%). Among CABG patients, the TVR rate was significantly higher in patients treated for graft lesions (n=65; 95.4% in vein grafts) than in patients treated for native coronary lesions only (n=137) (18.5% vs. 5.1%, P=0.002). Among 1638 patients with PCI of native coronary lesions only, there was only a non-significant difference in TVR between patients with previous CABG versus patients without previous CABG (5.1% vs. 2.3%, P=0.08). CONCLUSIONS: Patients with previous CABG showed a favorable safety profile after PCI with second-generation DES. Nevertheless, their TVR rate was still much higher, driven by more repeat revascularizations after PCI of degenerated vein grafts. In native coronary lesions, there was no such difference.
RCT Entities:
BACKGROUND:Patients with previous coronary artery bypass grafting (CABG) who underwent percutaneous coronary intervention (PCI) have an increased repeat revascularization rate, but data on contemporary second-generation drug-eluting stents (DES) are scarce. METHODS: We evaluated 1-year clinical outcome following secondary revascularization by PCI in patients of the TWENTE trial and non-enrolled TWENTE registry, and compared patients with previous CABG versus patients without previous CABG. RESULTS: Of all 1709 consecutive patients, 202 (11.8%) had previously undergone CABG (on average 11.2±8.5 years ago). CABG patients were older (68.5±9.4 years vs. 64.1±10.7 years, P<0.001) and more often had diabetes (28.7% vs. 20.9%, P=0.01) and previous PCI (40.1% vs. 19.8%, P<0.001) compared to patients without previous CABG. Nevertheless, a higher target vessel revascularization (TVR) rate following PCI in the CABG patients (9.4% vs. 2.3%, P<0.001) was the only significant difference in clinical outcome at 1-year follow-up (available for 99.6%). Among CABG patients, the TVR rate was significantly higher in patients treated for graft lesions (n=65; 95.4% in vein grafts) than in patients treated for native coronary lesions only (n=137) (18.5% vs. 5.1%, P=0.002). Among 1638 patients with PCI of native coronary lesions only, there was only a non-significant difference in TVR between patients with previous CABG versus patients without previous CABG (5.1% vs. 2.3%, P=0.08). CONCLUSIONS:Patients with previous CABG showed a favorable safety profile after PCI with second-generation DES. Nevertheless, their TVR rate was still much higher, driven by more repeat revascularizations after PCI of degenerated vein grafts. In native coronary lesions, there was no such difference.
Authors: Liefke C van der Heijden; Marlies M Kok; Ming Kai Lam; Peter W Danse; Alexander R Schramm; Gillian A J Jessurun; R Melvyn Tjon Joe Gin; K Gert van Houwelingen; Raymond W M Hautvast; Gerard C M Linssen; Hanim Sen; Marije M Löwik; Maarten J IJzerman; Carine J M Doggen; Clemens von Birgelen Journal: Clin Res Cardiol Date: 2015-09-02 Impact factor: 5.460
Authors: Liefke C van der Heijden; Marlies M Kok; Paolo Zocca; Hanim Sen; Marije M Löwik; Silvia Mariani; Frits H A F de Man; Marc Hartmann; Martin G Stoel; K Gert van Houwelingen; J Hans W Louwerenburg; Gerard C M Linssen; Carine J M Doggen; Jan G Grandjean; Clemens von Birgelen Journal: J Am Heart Assoc Date: 2018-01-30 Impact factor: 5.501