Bifurcation Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Graft Surgery: Analysis from the PROGRESS-Bifurcation Registry

Abstract

Background: Bifurcation percutaneous coronary intervention (PCI) is understudied in patients with prior coronary artery bypass graft surgery (CABG). Objectives: We sought to evaluate the clinical and procedural characteristics, and outcomes of bifurcation PCI in patients with versus without prior CABG. Methods: We compared the technical, procedural characteristics and outcomes of patients with and without prior CABG among 1305 patients who underwent 1496 bifurcation PCIs at five centers between 2014 and 2024. Results: Prior CABG patients accounted for 14.4 % of the study population, were older and had more cardiovascular risk factors and higher angiographic complexity, including higher rates of moderate or severe proximal main vessel tortuosity and calcification. Technical (95.0% vs 94.8%, p=0.942) and procedural (91.5% vs 91.1%, p=0.875) success were similar in patients with and without prior CABG; provisional stenting was used less frequently in prior CABG patients (60.6 % vs 68.0 %, p = 0.031). Prior CABG patients had lower rates of side branch occlusion after adjusting for confounders (adjusted odds ratio [OR]: 0.27, 95 % confidence intervals [CI]: 0.08, 0.72, p = 0.018) and similar in-hospital major adverse cardiovascular events (3.7 % vs 4.1 %, p = 0.800). During a median follow-up of 1095 days, prior CABG patients had higher incidence of target vessel revascularization (adjusted hazard ratio [HR]: 1.71, 95 % CI: 1.01, 2.89, p = 0.004). In patients with prior CABG, those who underwent PCI involving the graft had more complex coronary anatomies but similar technical success and short- and long-term outcomes. Conclusions: Prior CABG patients undergoing bifurcation PCI had lower risk of SBO and higher follow-up TVR. Among prior CABG patients PCI involving a bypass graft was associated with similar in-hospital and follow-up outcomes as PCI of a native vessel. © 2025 Elsevier Inc.