PCI in patients with previous CABG

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.

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. This significant difference is caused by a higher risk of procedural complications, including the no-reflow phenomenon and periprocedural MI.^[2]^[3]^[4]^[5]
The risk of distal debris embolization during PCI is high in PCI of an saphenous vein graft Compared with PCI of native coronary arteries since atherosclerotic plaques in saphenous vein graft are more diffuse, with thinner, and more friable fibrous caps.^[6]

Embolic Protection Devices

Embolic protection devices are a group of devices designed and used to prevent distal embolization.
Usage of these devices showed capability of significantly reducing the rate of major adverse cardiovascular events (such as cardiac death, stent thrombosis, and ischemia-driven target-vessel revascularization) in patients undergoing PCI of a saphenous vein graft.^[7]
A study that compared different embolic protection devices showed that the FilterWire EX device is not inferior to the GuardWire.^[8]

References

↑ ^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).
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ “Correction”. Circulation. 131 (24): e535. 2015. doi:10.1161/CIR.0000000000000219. PMID 26078378.
↑ 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.

[pmid34895950-1] 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).

[pmid17925610-2] 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.

[pmid27085582-3] 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.

[pmid21851896-4] 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.

[pmid28495896-5] 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.

[pmid27194091-6] 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.

[pmid26078378-7] “Correction”. Circulation. 131 (24): e535. 2015. doi:10.1161/CIR.0000000000000219. PMID 26078378.

[pmid12874191-8] 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.

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