PCI in patients with previous CABG

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Incidence of major adverse cardiovascular events is significantly higher among patients with previous history of CABG undergoing PCI of a saphenous vein graft compared to those with native coronary artery PCI. PCI of an saphenous vein graft is associated with a higher rate of distal debris embolization during PCI. Embolic protection devices are a group of devices designed and used to prevent distal embolization.

2021 ACA Revascularization Guideline

Class 2a Recommendation, Level of Evidence: B-R[1]
Usage of an embolic protection device, when technically feasible, is reasonable in order to decrease the risk of distal embolization in patients with previous CABG who are undergoing PCI of a saphenous vein graft.
Class 2a Recommendation, Level of Evidence: B-NR [1]
If feasible, PCI of the native coronary artery is preferred over the PCI of a severely diseased saphenous vein graft in patients with previous CABG.
Class 3 Recommendation: No Benefit, Level of Evidence: C-LD [1]
PCI of a saphenous vein graft should be avoided in patients with a chronic occlusion of a saphenous vein graft.

Embolic Protection Devices

References

  1. 1.0 1.1 1.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  2. Hoffmann R, Hamm C, Nienaber CA, Levenson B, Bonzel T, Sabin G; et al. (2007). "Implantation of sirolimus-eluting stents in saphenous vein grafts is associated with high clinical follow-up event rates compared with treatment of native vessels". Coron Artery Dis. 18 (7): 559–64. doi:10.1097/MCA.0b013e3282ef5b40. PMID 17925610.
  3. Brilakis ES, O'Donnell CI, Penny W, Armstrong EJ, Tsai T, Maddox TM; et al. (2016). "Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients With Prior Coronary Artery Bypass Graft Surgery: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program". JACC Cardiovasc Interv. 9 (9): 884–93. doi:10.1016/j.jcin.2016.01.034. PMID 27085582.
  4. Brilakis ES, Rao SV, Banerjee S, Goldman S, Shunk KA, Holmes DR; et al. (2011). "Percutaneous coronary intervention in native arteries versus bypass grafts in prior coronary artery bypass grafting patients: a report from the National Cardiovascular Data Registry". JACC Cardiovasc Interv. 4 (8): 844–50. doi:10.1016/j.jcin.2011.03.018. PMID 21851896.
  5. Redfors B, Généreux P, Witzenbichler B, McAndrew T, Diamond J, Huang X; et al. (2017). "Percutaneous Coronary Intervention of Saphenous Vein Graft". Circ Cardiovasc Interv. 10 (5). doi:10.1161/CIRCINTERVENTIONS.117.004953. PMID 28495896.
  6. de Vries MR, Simons KH, Jukema JW, Braun J, Quax PH (2016). "Vein graft failure: from pathophysiology to clinical outcomes". Nat Rev Cardiol. 13 (8): 451–70. doi:10.1038/nrcardio.2016.76. PMID 27194091.
  7. "Correction". Circulation. 131 (24): e535. 2015. doi:10.1161/CIR.0000000000000219. PMID 26078378.
  8. Stone GW, Rogers C, Hermiller J, Feldman R, Hall P, Haber R; et al. (2003). "Randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts". Circulation. 108 (5): 548–53. doi:10.1161/01.CIR.0000080894.51311.0A. PMID 12874191.