OUTCOMES OF PCI IN PATIENTS WITH PREVIOUS CORONARY ARTERY BYPASS GRAFTING (CABG) IN PAKISTAN
Main Article Content
Keywords
Coronary artery disease, Percutaneous coronary intervention, Coronary artery bypass grafting, Procedural success, Major adverse cardiac events, Post-procedural complications
Abstract
Background: Coronary artery disease (CAD) is a prevalent condition requiring significant medical intervention. Coronary artery bypass grafting (CABG) is a common treatment for severe CAD; however, grafts can develop stenosis or occlusion over time, necessitating further interventions such as percutaneous coronary intervention (PCI). This study aims to evaluate the outcomes of PCI in patients with previous CABG in Pakistan, focusing on procedural success rates, in-hospital mortality, major adverse cardiac events (MACE), and post-procedural complications.
Methods: This prospective observational study was conducted at Hayatabad Medical Complex, Peshawar, from January 2020 to December 2022. The study included 303 patients, aged 40-89 years, who had significant graft stenosis or occlusion post-CABG and underwent PCI. Baseline and follow-up data were collected through structured interviews and medical record reviews. Primary outcomes measured were procedural success rates, in-hospital mortality, and MACE. Secondary outcomes included post-procedural complications and 30-day readmission rates. Statistical analyses were performed using SPSS version 26.0, with paired t-tests and multivariate logistic regression applied to identify predictors of complications.
Results: The mean age of participants was 65.3 years, with 71% males. Significant graft stenosis was observed in 68% of patients, with the left internal mammary artery (LIMA) and saphenous vein grafts (SVG) most commonly affected. The procedural success rate was 92%, with in-hospital mortality at 3.3%. MACE occurred in 15.5% of patients, including recurrent myocardial infarction (4%) and emergency CABG (1.7%). Post-procedural complications were noted in 25% of patients, including bleeding (8%), vascular complications (5%), and contrast-induced nephropathy (12%). The 30-day readmission rate was 18%.
Conclusion: PCI is a viable option for patients with previous CABG, demonstrating high procedural success and acceptable rates of complications. These findings support the integration of PCI into clinical practice for managing graft stenosis post-CABG in Pakistan. Future research should focus on long-term outcomes and further refinement of patient selection criteria to optimize treatment strategies.
Methods: This prospective observational study was conducted at Hayatabad Medical Complex, Peshawar, from January 2020 to December 2022. The study included 303 patients, aged 40-89 years, who had significant graft stenosis or occlusion post-CABG and underwent PCI. Baseline and follow-up data were collected through structured interviews and medical record reviews. Primary outcomes measured were procedural success rates, in-hospital mortality, and MACE. Secondary outcomes included post-procedural complications and 30-day readmission rates. Statistical analyses were performed using SPSS version 26.0, with paired t-tests and multivariate logistic regression applied to identify predictors of complications.
Results: The mean age of participants was 65.3 years, with 71% males. Significant graft stenosis was observed in 68% of patients, with the left internal mammary artery (LIMA) and saphenous vein grafts (SVG) most commonly affected. The procedural success rate was 92%, with in-hospital mortality at 3.3%. MACE occurred in 15.5% of patients, including recurrent myocardial infarction (4%) and emergency CABG (1.7%). Post-procedural complications were noted in 25% of patients, including bleeding (8%), vascular complications (5%), and contrast-induced nephropathy (12%). The 30-day readmission rate was 18%.
Conclusion: PCI is a viable option for patients with previous CABG, demonstrating high procedural success and acceptable rates of complications. These findings support the integration of PCI into clinical practice for managing graft stenosis post-CABG in Pakistan. Future research should focus on long-term outcomes and further refinement of patient selection criteria to optimize treatment strategies.
References
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10. Claessen BE, Smits PC, Kereiakes DJ, et al. Impact of lesion complexity and operator technique on outcomes with the Resolute zotarolimus-eluting stent: insights from the TWENTE trial. J Am Coll Cardiol. 2014;64(12):1147-1156. doi:10.1016/j.jacc.2014.06.1172.
11. Guo LW, Zhou YQ, Yang Q, et al. Impact of pre-PCI fractional flow reserve on clinical outcomes in patients with intermediate coronary lesions: a meta-analysis. PLoS One. 2015;10(6). doi:10.1371/journal.pone.0130360.
12. De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367(11):991-1001. doi:10.1056/NEJMoa1205361.
13. Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503-2515. doi:10.1056/NEJMoa0805796.
14. Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis: a pooled analysis of three randomized trials. J Am Coll Cardiol. 2014;64(24):2352-2360. doi:10.1016/j.jacc.2014.09.039.
15. Epstein AJ, Polsky D, Yang F, et al. Coronary revascularization trends in the United States, 2001-2008. JAMA. 2011;305(17):1769-1776. doi:10.1001/jama.2011.551.
16. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61(3). doi:10.1016/j.jacc.2012.11.007.
2. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. doi:10.1093/eurheartj/ehy394.
3. Head SJ, Milojevic M, Daemen J, et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J. 2014;35(40):2821-2830. doi:10.1093/eurheartj/ehu213.
4. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961-972. doi:10.1056/NEJMoa0804626.
5. Stone GW, Kandzari DE, Mehran R, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in left main and/or three-vessel coronary artery disease: the EXCEL trial. N Engl J Med. 2016;375(23):2223-2235. doi:10.1056/NEJMoa1610227.
6. Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125(23):2873-2891. doi:10.1161/CIRCULATIONAHA.112.097014.
7. Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516. doi:10.1056/NEJMoa070829.
8. Kappetein AP, Head SJ, Morice MC, et al. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary interventions in the SYNTAX trial. Eur J Cardiothorac Surg. 2013;43(5):1006-1013. doi:10.1093/ejcts/ezt386.
9. Banning AP, Westaby S, Morice MC, et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol. 2010;55(11):1067-1075. doi:10.1016/j.jacc.2009.09.065.
10. Claessen BE, Smits PC, Kereiakes DJ, et al. Impact of lesion complexity and operator technique on outcomes with the Resolute zotarolimus-eluting stent: insights from the TWENTE trial. J Am Coll Cardiol. 2014;64(12):1147-1156. doi:10.1016/j.jacc.2014.06.1172.
11. Guo LW, Zhou YQ, Yang Q, et al. Impact of pre-PCI fractional flow reserve on clinical outcomes in patients with intermediate coronary lesions: a meta-analysis. PLoS One. 2015;10(6). doi:10.1371/journal.pone.0130360.
12. De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367(11):991-1001. doi:10.1056/NEJMoa1205361.
13. Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503-2515. doi:10.1056/NEJMoa0805796.
14. Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis: a pooled analysis of three randomized trials. J Am Coll Cardiol. 2014;64(24):2352-2360. doi:10.1016/j.jacc.2014.09.039.
15. Epstein AJ, Polsky D, Yang F, et al. Coronary revascularization trends in the United States, 2001-2008. JAMA. 2011;305(17):1769-1776. doi:10.1001/jama.2011.551.
16. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61(3). doi:10.1016/j.jacc.2012.11.007.
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Published
May 25, 2024
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How to Cite
Dr Syed Muzammil Shah, Dr Honey Raj Vishno, Dr Tariq Shah, Dr Muhammad Abdul Wahab, Dr Rafi Ullah, & Dr Rukhana. (2024). OUTCOMES OF PCI IN PATIENTS WITH PREVIOUS CORONARY ARTERY BYPASS GRAFTING (CABG) IN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(5), 2060-2066. https://doi.org/10.53555/jptcp.v31i5.7132
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Author Biographies
Dr Syed Muzammil Shah
Medical Officer, Hayatabad Medical Complex Peshawar, PakistanDr Honey Raj Vishno
Cardiology Resident, NICVD, Karachi, PakistanDr Tariq Shah
Cardiologist, Hayatabad Medical Complex, Peshawar
Dr Muhammad Abdul Wahab
Associate Physician of Cardiology Federal Govt: Polyclinic Islamabad
Dr Rafi Ullah
Cardiologist, Kuwait Teaching Hospital Peshawar
Dr Rukhana
Postgraduate Resident Radiology, Khyber teaching hospital, Peshawar
How to Cite
Dr Syed Muzammil Shah, Dr Honey Raj Vishno, Dr Tariq Shah, Dr Muhammad Abdul Wahab, Dr Rafi Ullah, & Dr Rukhana. (2024). OUTCOMES OF PCI IN PATIENTS WITH PREVIOUS CORONARY ARTERY BYPASS GRAFTING (CABG) IN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 31(5), 2060-2066. https://doi.org/10.53555/jptcp.v31i5.7132