Abstract 15184: Incidence and Impact of Coronary Re-Intervention After Index Coronary Artery Bypass Graft Surgery

IntroductionThe incidence of re-intervention for recurrent ischemia after coronary artery bypass grafting (CABG) and its impact on survival are not well documented.HypothesisOur regional medical center being the sole provider for coronary procedures in a geographically isolated and stable population, we could reliably evaluate the role of coronary re-intervention on mid-term survival after index CABG.MethodsData were collected from our STS and cardiac catheterization laboratory databases in consecutive patients undergoing isolated CABG from 1/1/2008 through 12/31/2016. Social Security was queried for long-term follow-up. Actuarial survival was used to compare groups requiring or not re-intervention, either redo-CABG or percutaneous intervention (PCI), after index CABG surgery.ResultsCABG was performed in 4,310 consecutive patients during the 8-year period of observation. Mean number of distal anastomosis was 3.9. Distal arterial anastomosis was performed in 96% of cases, using at least one internal mammary artery. Early unadjusted mortality was 1.57% with a predicted risk score of 1.73%. Re-intervention was required in 250 casesrepeat CABG in 12 and PCI in 238. The mean time to re-intervention was 2.67 years, range 13 days to 7 years. Between-groups baseline characteristics were significantly different, with patients who required additional coronary procedures being older, having undergone more prior coronary interventions, demonstrating worse baseline and late renal function, having lower ejection fraction and receiving more distal anastomosis at the time of index CABG. Survival at up to 8 years (when 654 patients were still exposed) was not significantly different between the 2 groups73.44% vs. 74.83% (Figure 1, log-rank testp= 0.091).ConclusionsContemporary CABG is safe with low perioperative risk and durable, with less than 6% of patients requiring re-intervention at 8 years post-surgery. Patients with markers of more advanced atherosclerotic burden at the time of CABG are more likely to require subsequent therapy. The majority of patients requiring post-CABG intervention are now treated with PCI. Regardless of the type of revascularization after CABG, re-intervention does not predicate worse midterm survival.