The presence of a patent graft in patients with previous coronary artery bypass graft (CABG) surgery is a significant predictor of chronic total occlusion (CTO) failure following percutaneous coronary intervention (PCI). The preferred revascularisation strategy for CTOs in patients with a history of CABG surgery is PCI. Researchers aimed to determine if the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes after CTO-PCI.
This multicentre study involved 259 patients who had previously undergone CABG and subsequently underwent CTO-PCI between 2019 and 2023 across 12 international centres. Patients were categorised into “grafted” (77%) and “ungrafted” (23%) groups based on the presence of a graft on the CTO vessel. The grafted group was further divided into “graft-occluded” and “graft-patent” subgroups depending on the post-PCI graft status. The results revealed that patients in the grafted group exhibited greater complexity and lower technical success rates compared to the ungrafted group (70% vs 80%, p = 0.004).
Within the grafted group, 70% of the CTOs were in the graft-occluded group, which had a significantly lower technical success rate than the graft-patent group (65% vs 81%, p = 0.022). The presence of an occluded graft was identified as an independent predictor of technical failure (odds ratio: 2.04; 95% CI:1.03 to 4.76; p=0.049). Additionally, persistent graft patency post-PCI was strongly associated with higher CTO failure (defined as the need for target vessel revascularization or significant in-stent restenosis) at 1 year (hazard ratio: 5.6; 95% ci: 1.2 to 27.5; p=0.033).
In conclusion, post-PCI graft patency in patients with previous CABG is a significant predictor of CTO failure following PCI. These results highlight the need for careful consideration in managing grafted CTOs. Future studies should explore strategies to improve outcomes in these patients, potentially through tailored interventions or more aggressive follow-up, given the impact on long-term clinical outcomes.
Katrina Thornber, EMJ
Reference
Poletti E et al. Impact of postprocedural graft flow on outcomes following chronic total occlusion intervention in postcoronary artery bypass graft patients: a detailed angiographic analysis. Am J Cardiol. 2024;DOI:10.1016/j.amjcard.2024.06.015.
