Outcomes Following PCI in Patients With Previous CABG: A Multi Centre Experience Shantu S. Bundhoo, 1 MBChB MRCP(UK), Manish Kalla, 1 BSc(Hons), MBBS, MRCP(UK), Rajaram Anantharaman, 2 MBBS, MRCP(UK), Keith Morris, 3 BSc, PhD, Alexander Chase, 2 MBBS, MRCP(UK), PhD, David Smith, 2 MBBS, MRCP(UK), MD, Richard A. Anderson, 1 * BSc(Hons), MBBS, FRCP(UK), MD, and Tim D. Kinnaird, 1 MBBS, MRCP(UK), MD Background: Limited data is available to guide operators as to the optimal revascular- isation strategy in patients with previous CABG representing with angina. Method: Ret- rospective analysis of 161 patients with prior CABG undergoing PCI in two centres between September 2005 and April 2008. Results: 161 patients (132 male, 68 6 8years) underwent PCI at 126 6 65 months after index CABG. Clinical presentation of recurrent ischaemia was stable in 59.7% and as an acute coronary syndrome in 40.3% of patients. Mean follow-up after PCI was 13.5 6 4.8 months. About 62.7% of patients underwent native vessel PCI, 32.9% had a graft only PCI, and 4.4% having a combina- tion of both. Drug eluting stents were used in 84.9% of cases. There was one cardiac death and one case of redo CABG during follow-up. Mean CCS angina class decreased from 2.87 to 0.67 (P < 0.0001) in the follow-up group. About 13.6 % of all patients had a MACE at follow up. This was higher in the graft PCI group (21.6% vs. 8.9%, P 5 0.048). About 12.4% of the total cohort underwent repeat PCI although 30% of these required PCI for a de-novo lesion. TVR rate was significantly higher in patients undergoing graft PCI than native vessel PCI (15% vs. 4.9%, P 5 0.031). Graft PCI was an independent predictor (HR 3.73, 1.27–10.87 [95%CI], P 5 0.016) of MACE in these patients. Conclusion: PCI significantly improved angina in these patients with low overall rates of TVR. However TVR rate was significantly higher in patients undergoing graft PCI than those undergoing native vessel PCI. V C 2011 Wiley-Liss, Inc. Key words: percutaneous coronary intervention; GRFT—bypass grafts coronary; outcomes INTRODUCTION The incidence of coronary artery disease is increas- ing worldwide, with over 800,000 patients undergoing revascularization with coronary artery bypass grafting (CABG) annually [1]. While most patents achieve complete revascularization for the treatment of sympto- matic multivessel disease with CABG, the number of repeat revascularization procedures in patients with CABG has been increasing over recent years [2,3]. Over the past three decades, saphenous vein grafts (SVGs) have been the most frequently used conduits followed by the internal mammary artery (IMA). Previ- ous studies assessing the long term patency of IMAs and SVGs using angiography have reported the IMA patency at 10 years being 85%, with SVG being patent in only 60% of patients [1]. Graft failure results in patients presenting with recurrent cardiac ischaemia as acute coronary syndromes or increasing angina refrac- tory to optimal medical therapy. The options for repeat revascularization in these patients are CABG or percu- taneous coronary intervention (PCI). A number of sin- gle centre studies [4–7] have reported that redo CABG also carries a relatively higher mortality than first time CABG with perioperative mortality figures reported between 2 and 7%. This increase may be explained by 1 Cardiothoracic Services, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom 2 Morriston Cardiac Centre, Morriston Hospital, Swansea, SA6 6NL, United Kingdom 3 Cardiff School of Health Sciences, University of Wales Insti- tute of Cardiff, Western Avenue, Cardiff, CF5 2YB, United Kingdom Conflict of interest: Nothing to report. *Correspondence to: Richard A. Anderson, BSc(Hons), MBBS, FRCP(UK), MD, Cardiothoracic Services, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom. E-mail: RAAnderson@tiscali.co.uk Received 30 July 2010; Revision accepted 20 September 2010 DOI 10.1002/ccd.22841 Published online 16 March 2011 in Wiley Online Library (wileyonlinelibrary.com) V C 2011 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 78:169–176 (2011)