Prior Coronary Artery Bypass Grafting Research Articles

Epicardial Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy.

Catheter ablation can effectively reduce the frequency of ventricular tachycardia in ischemic cardiomyopathy by ablating sites of reentry within complex regions of myocardial scar. In cases of near transmural infarction, this arrhythmia substrate may be nearer the epicardium than the endocardium, and epicardial ablation may be necessary. An epicardial substrate location can potentially be predicted by imaging that suggests transmural infarction. Percutaneous epicardial ablation improves outcomes in selected patients, but is higher risk and avoided in patients with prior coronary artery bypass grafting.

A Clinical Tool to Identify Candidates for Stress-First Myocardial Perfusion Imaging

ObjectivesThis study sought to develop a clinical model that identifies a lower-risk population for coronary artery disease that could benefit from stress-first myocardial perfusion imaging (MPI) protocols and that can be used at point of care to risk stratify patients. BackgroundThere is an increasing interest in stress-first and stress-only imaging to reduce patient radiation exposure and improve patient workflow and experience. MethodsA secondary analysis was conducted on a single-center cohort of patients undergoing single-photon emission computed tomography (SPECT) and positron emission tomography (PET) studies. Normal MPI was defined by the absence of perfusion abnormalities and other ischemic markers and the presence of normal left ventricular wall motion and left ventricular ejection fraction. A model was derived using a cohort of 18,389 consecutive patients who underwent SPECT and was validated in a separate cohort of patients who underwent SPECT (n = 5,819), 1 internal cohort of patients who underwent PET (n=4,631), and 1 external PET cohort (n = 7,028). ResultsFinal models were made for men and women and consisted of 9 variables including age, smoking, hypertension, diabetes, dyslipidemia, typical angina, prior percutaneous coronary intervention, prior coronary artery bypass graft, and prior myocardial infarction. Patients with a score ≤1 were stratified as low risk. The model was robust with areas under the curve of 0.684 (95% confidence interval [CI]: 0.674 to 0.694) and 0.681 (95% CI: 0.666 to 0.696) in the derivation cohort, 0.745 (95% CI: 0.728 to 0.762) and 0.701 (95% CI: 0.673 to 0.728) in the SPECT validation cohort, 0.672 (95% CI: 0.649 to 0.696) and 0.686 (95% CI: 0.663 to 0.710) in the internal PET validation cohort, and 0.756 (95% CI: 0.740 to 0.772) and 0.737 (95% CI: 0.716 to 0.757) in the external PET validation cohort in men and women, respectively. Men and women who scored ≤1 had negative likelihood ratios of 0.48 and 0.52, respectively. ConclusionsA novel model, based on easily obtained clinical variables, is proposed to identify patients with low probability of having abnormal MPI results. This point-of-care tool may be used to identify a population that might qualify for stress-first MPI protocols.

Feasibility and Durability of the Modified Cabrol Coronary Artery Reattachment Technique

This study evaluated the feasibility and durability of the modified Cabrol coronary reattachment technique after aortic root replacement. The study retrospectively reviewed 370 patients who underwent aortic root replacement, during 1991 and 2018, and who were separated into 2 groups: a modified Carol (mCabrol) group (n= 84), consisting of patients with 1 or both coronary ostia reimplanted using a modified Cabrol technique; and a Carrel group (n= 286), consisting of patients with both coronary ostia reimplanted using the Carrel button technique. Baseline characteristics were similar in the 2 groups, except the mCabrol group had higher rates of redo sternotomy (74% vs 16%), chronic aortic dissection (58% vs 19%), and infection (14% vs 3%). In the mCabrol group, 60% had both coronary arteries reattached with the technique, and 40% of the procedures were unilateral. Operative mortality was significantly higher in mCabrol group compared with the Carrel group. However, in the stratified analysis for resternotomy, operative mortality between 2 groups were similar (16% vs 13%; P= .786). The survival rate at 5 years and 10 years was 68 ± 6% and 44 ± 6%, respectively, in the mCabrol group and 87 ± 2% and 80 ± 3%, respectively, in the Carrel group (log-rank P < .001). After propensity adjustment, chronic kidney disease and prior coronary artery bypass grafting, but not the modified Cabrol technique, were independent predictors of both operative mortality and follow-up mortality (operative, P= .518; follow-up, P= .080). A total of 47 (66%) of 71 discharged patients in the mCabrol group had follow-up imaging, and no Cabrol graft was occluded. Two patients in the mCabrol group required interventions related to the reattachment technique: 1 coronary ostial anastomosis stenosis and 1 graft-to-graft anastomosis pseudoaneurysm. The modified Cabrol reattachment technique was not predictive of increased mortality and has excellent patency.

In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with and without prior coronary artery bypass graft: A protocol for systematic review and meta analysis.

The clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in prior coronary artery bypass graft (pCABG) patients have been investigated; however, the results are inconsistent.The present meta-analysis compared the clinical outcomes of CTO PCI in patients with and without prior CABG (nCABG). The endpoints included technical success, procedural success, all-cause mortality, myocardial infarction (MI), major bleeding, coronary perforation, pericardial tamponade, emergency CABG, and vascular access complication.A total of 7 studies comprising of 11099 patients were included in this meta-analysis. The results showed that compared to nCABG patents, pCABG patients were associated with lower technical success (82.3% versus 87.8%; OR, 0.60; 95% CI, 0.53–0.68; P < .00001; I2 = 0%) and procedural success (80.4% versus 86.2%; OR, 0.61; 95% CI, 0.53–0.70; P < .00001; I2 = 10%); a higher risk of all-cause mortality (OR, 2.95; 95% CI, 1.56–5.57; P = 0.0008; I2 = 0%), MI (OR, 2.30; 95% CI, 1.40–3.80; P = .001; I2 = 5%), and coronary perforation (OR, 2.16; 95% CI, 1.51–3.08; P < 0.0001; I2 = 52%). On the other hand, the risk of pericardial tamponade (OR, 0.42; 95% CI, 0.15–1.18; P = .10; I2 = 21%), major bleeding (OR, 1.51; 95% CI, 0.90–2.53; P = .11; I2 = 0%), vascular access complication (OR, 1.50; 95% CI, 0.93–2.41; P = .10; I2 = 0%), and emergency CABG (OR, 0.99; 95% CI, 0.25–3.91; P = .99; I2 = 0%) was similar in both groups.Compared to nCABG patients, pCABG patients had lower CTO PCI success rates, higher rates of in-hospital mortality, MI, and coronary perforation, and similar risk of pericardial tamponade and vascular complication rates.

Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion-percutaneous coronary intervention: Procedural and clinical outcomes from the REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium, and UnitEd Kingdom (RECHARGE).

Chronic total occlusions (CTO) in patients with history of coronary artery bypass graft (CABG) show more advanced and complex atherosclerotic pathology. Aim of our study is to compare outcomes in patients undergoing CTO percutaneous coronary intervention (PCI) with previous CABG versus those without in the REgistry of Crossboss and Hybrid procedures in FrAnce the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE). The RECHARGE cohort (1,252 patients) was divided in two groups according to the presence of previous CABG (217) or not. We also focused, in the post-CABG group, on a comparison between CTO in previously grafted vessels versus non-grafted vessels. The CTO complexity scores were higher and the success rate (71.9% vs. 88.7%, p < .001) was lower in the CABG group, this difference was driven by higher failure rates in high-complexity-score CTO. The rate of in-hospital complications was similar. In the post-CABG group, the procedural success of CTO located in previously grafted vessels versus those in vessels not previously grafted, was comparably suboptimal (73.1% vs. 68%, p = .47). Patients undergoing CTO PCI with prior CABG have a higher prevalence of comorbidities and more complex lesion characteristics. In the post-CABG population the success rate was significantly lower, particularly in high CTO complexity scores, though complication rates were comparable. In the post-CABG population, the CTO success rate was independent of the presence of a previous graft on the CTO vessel.

Clinical profile of post coronary artery bypass graft patients undergoing percutaneous coronary intervention in native or graft vessels

Background: The PCI target vessel and corresponding outcomes in prior CABG patients are poorly studied. The study aims to determine the predictors and outcomes of native coronary artery and bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery (CABG).Methods: The factors associated with native and bypass graft PCI were analyzed in prior CABG patients undergoing PCI between July 2011 and December 2013, at Sri Jayadeva Institute Of Cardiovascular Sciences and Research, Bengaluru. Clinical/procedural characteristics and immediate procedural outcomes were recorded and analyzed.Results: During the study period, 76 patients underwent PCI who were before CABG patients. The PCI target was a native coronary artery in 73.6% and a bypass graft in 28.9%. The majority of patients presented more than five years after the CABG (64.4%). Post PCI angina was seen in 7(9.2%), and in 6(7.8%) patients, procedural complications seen. It was found that most PCI was done in patients who presented more than five years after CABG.Conclusions: Most PCIs performed in prior CABG patients are done in native coronary artery lesions.

Surgical Management for Acute Occlusion of the Left Main Coronary Artery Stenosis: A Case Series

There is growing global attention concerning the short and long term prognosis of acute coronary syndrome (ACS) in patients with prior coronary artery bypass grafting (CABG). Significant left main coronary artery (LMCA) disease occurs in 5%-7% of patients undergoing coronary angiography, which is associated with a worse prognosis. We report a series of 3 patients presenting with LMCA disease out of which one patient successfully underwent CABG, and two patients managed with optimal medical therapy.

Percutaneous coronary intervention in diabetic versus non-diabetic patients with prior coronary artery bypass grafting: a propensity score matching study

BackgroundThe target of this study was to explore the outcomes of percutaneous coronary intervention (PCI) in diabetic versus non-diabetic patients with prior coronary artery bypass grafting (CABG) surgery.MethodsSeven hundred and twenty four patients who had previously received CABG and had been treated using PCI combined with drug-eluting stents (DES) between 2009 and 2017 were selected for a retrospective study and allocated into either a diabetes mellitus (DM) or non-diabetes mellitus (No DM) group. A 1:1 propensity score-matched evaluation was conducted and risk adjusted for analysis. The primary outcomes were cardiac death, myocardial infarction, heart failure and revascularization, with a median follow-up duration of 5.13 years.ResultsAfter matching, two-, 5- and 8-year event rate of overall major adverse cardiac events (MACEs) were found to be higher in the DM group (No DM vs DM:15.3, 30.9, 38.5% vs 19.8, 37.8, 52.2%, respectively), although no significant difference was found in the event rate of overall MACEs (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.00 to 1.83 for DM vs No DM; P = 0.052), cardiac death (HR: 0.94; 95% CI: 0.45 to 1.95; P = 0.871), MI (HR: 1.49; 95% CI: 0.95 to 2.32; P = 0.080), HF (HR: 1.54; 95% CI: 0.90 to 2.63 for; P = 0.120) or revascularization (HR: 1.07; 95% CI: 0.72 to 1.59; P = 0.747). Subgroup analysis of PCI in only the NCA showed MACEs (adjusted HR: 1.13; 95% CI: 0.85 to 1.49 for DM vs No DM; P = 0.325), cardiac death (adjusted HR: 0.85; 95% CI: 0.41 to 1.78 for DM vs No DM; P = 0.781), MI (adjusted HR: 1.32; 95% CI: 0.84 to 2.01 for DM vs No DM; P = 0.069), HF (adjusted HR: 1.41; 95% CI: 0.87 to 2.27 for DM vs No DM; P = 0.211) or repeated revascularization (adjusted HR: 0.93; 95% CI: 0.64 to 1.37 for DM vs No DM; P = 0.836).ConclusionsCompared with non-diabetic patients with prior CABG, subsequent implantation of DES in the native coronary artery of diabetic patients resulted in apparently similar outcomes.Trial registrationThis study was not registered in an open access database.

Characteristics and Outcome of Patients ≥75 Years of Age With Prior Coronary Artery Bypass Grafting Admitted for an Acute Coronary Syndrome

The prognostic role of previous coronary artery bypass (CABG) in elderly patients admitted to hospital for an acute coronary syndrome (ACS) is unclear. Therefore, the aim of this study was to compare the prognosis of patients aged ≥75 years admitted for an ACS with or without previous history of CABG. The primary outcome of the study was a composite of overall mortality, recurrent nonfatal myocardial infarction, nonfatal stroke, and rehospitalization for heart failure at 1-year follow-up. We included 2,253 ACS patients, aged 81 (78 to 85) years enrolled in 3 multicenter studies (the Italian Elderly ACS study, the LADIES ACS study, and the Elderly ACS 2 randomised trial) - 178 (7.9%) with previous CABG, 2,075 (92.1%) without. Patients with previous CABG had a higher burden of cardiovascular risk factors, lower ejection fraction, and higher creatinine values on admission. However, both at univariate analysis and after adjustment for the most relevant covariates (sex, age, previous myocardial infarction, type of ACS, left ventricular ejection fraction, and serum creatinine on admission), previous CABG did not show any statistically significant association with 1-year outcome (adjusted hazard ratio 0.85; 95% confidence interval 0.61 to 1.19; p = 0.353). In conclusion, our study suggests that elderly ACS patients with previous CABG have worse basal clinical characteristics. Nevertheless, in a broad cohort of patients mostly treated with percutaneous coronary intervention during the index event, previous CABG did not confer independent additional risk of major adverse cardiovascular events at 1-year follow-up.

Transradial and Transfemoral Approach in Patients with Prior Coronary Artery Bypass Grafting.

The relationship between periprocedural complications and the type of vascular access in patients with prior history of coronary artery bypass grafting (CABG) and treated with percutaneous coronary interventions (PCIs) is less investigated than in the overall group of patients treated with PCI. The aim of the current study was to assess the relationship between the type of vascular access and selected periprocedural complications in a group of patients with prior history of CABG and treated with PCIs. Based on a Polish nationwide registry of interventional cardiology procedures called ORPKI, the authors analyzed 536,826 patients treated with PCI between 2014 and 2018. The authors extracted 32,225 cases with prior history of CABG. Then, patients with femoral and radial access as well as right and left radial access were compared. This comparison was proceeded by propensity score matching (PSM). After PSM, a multifactorial analysis revealed that patients treated with PCI from femoral access were significantly more often related to periprocedural deaths (odds ratio [OR]: 1.79; 95%, confidence interval [CI]: 1.1–3.0, p = 0.02) and cardiac arrests (OR: 1.98; 95%, CI: 1.38–2.87, p < 0.001). After inclusion of the Killip class grade and the occurrence of cardiac arrests before PCI into the PSM, the significance remained for procedural related cardiac arrests (OR: 1.55; 95%, CI: 1.07–2.28, p = 0.022]). However, a comparison of right and left radial access showed no significant differences between procedure-related complications. It has been confirmed that there is a statistical association between femoral access (compared to radial access) and a higher rate of periprocedural cardiac arrests in patients with prior history of CABG treated with PCI.

Acute coronary syndrome in patients with prior coronary artery bypass graft: clinical, angiographic profiles and management practices

Acute coronary syndrome (ACS) among patients with post-coronary artery bypass graft (CABG) is not uncommonly encountered in current clinical practice. This study aimed to investigate the clinical and angiographic profiles and management strategies among post-CABG patients presenting with ACS at a

LONG-TERM ADVERSE ISCHEMIC OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG PATIENTS BY PRIOR CORONARY ARTERY BYPASS GRAFTING STATUS: ANALYSIS FROM 19 RANDOMIZED TRIALS

Previous studies have suggested that patients with prior coronary artery bypass graft (CABG) surgery are at elevated risk when undergoing repeat revascularization compared to those without prior bypass surgery. However, there are limited long-term outcomes data for such patients. We studied the

Acute myocardial infarction-cardiogenic shock in patients with prior coronary artery bypass grafting: A 16-year national cohort analysis of temporal trends, management and outcomes

BackgroundThere are limited data on the outcomes of acute myocardial infarction with cardiogenic shock (AMI-CS) in patients with prior coronary artery bypass grafting (CABG). MethodsA retrospective cohort of AMI-CS admissions during 2000–2016 from the National Inpatient Sample was created and prior CABG status was identified. Outcomes of interest included in-hospital mortality and resource utilization in the two cohorts. Temporal trends of prevalence, in-hospital mortality, and cardiac procedures were evaluated. ResultsIn 513,288 AMI-CS admissions, prior CABG was performed in 22,832 (4.4%). Adjusted temporal trends showed a 2-fold increase in CS in both cohorts. There was a temporal increase in coronary angiography and percutaneous coronary intervention (PCI) across both cohorts. The cohort with prior CABG was on average older, of male sex, of white race, and with higher comorbidity. The cohort with prior CABG received coronary angiography (50% vs. 75%), PCI (32% vs. 49%), right heart catheterization/pulmonary artery catheterization (15% vs. 20%), mechanical circulatory support (26% vs. 46%) less frequently compared to those without (all p < 0.001). The cohort with CABG had higher in-hospital mortality (53% vs. 37%; adjusted odds ratio 1.41 [95% confidence interval 1.36–1.46]), greater use of do not resuscitate status (13% vs. 6%), shorter lengths of hospital stay (7 ± 8 vs. 10 ± 12 days), lower hospitalization costs ($92,346 ± 139,565 vs. 138,508 ± 172,895) and fewer discharges to home (39% vs. 43%) (all p < 0.001). ConclusionsIn AMI-CS, admission with prior CABG was older and had lower use of cardiac procedures and higher in-hospital mortality compared to those without prior CABG.

CRT-100.75 Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With and Without Prior Coronary Artery Bypass Grafts: A Comparison of Patient Characteristics and Outcomes

Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are therapeutic options for patients with chronic total occlusions (CTO). Some patients require CTO PCI after having CABG surgery. This study sought to assess differences in demographics, comorbidities and in-

Computed tomography cardiac angiography for planning invasive angiographic procedures in patients with previous coronary artery bypass grafting

Invasive coronary angiography (ICA) is more complex and challenging in patients with previous coronary artery bypass grafts (CABG). Computed tomography coronary angiography (CTCA) may provide useful information prior to ICA to improve these procedures. This study aimed to see if upfront CTCA prior to coronary angiography can reduce contrast load, procedural duration, and procedural complications compared to ICA alone. This single-centre observational study included 835 patients with prior CABG undergoing invasive coronary angiography. One hundred and six patients underwent CTCA prior to ICA and were compared to 729 patients undergoing conventional coronary angiography alone (control group). No significant differences were seen between the two groups in patient demographics and procedural characteristics (number of bypass grafts), and interventional cardiologists' experience. The CTCA group had lower contrast volumes (171.3 vs 287.4 ml, p<0.0001), radiation doses (effective dose 4.6 vs 10.5 mSv, p<0.0001) and procedure times (fluorosocopy time 9.5 vs 12.6 min, p<0.0001) at the time of ICA compared to patients who did not have prior CTCA. Combined radiation doses (ICA+CTCA) versus ICA alone were similar (p=0.867) with significant reductions in overall contrast used seen in the CTCA group (p=0.005). Complete diagnostic studies were performed in all patients with prior CTCA (106 patients, 100%) compared to 543 patients (74.64%, p=<0.0001) without previous CTCA. As a result, 34 patients (4.4%) went on to have CTCA post angiography due to missed grafts. Of these, four needed further invasive angiographic assessment and subsequent coronary intervention following the CTCA scan. Prior CTCA improves graft detection at the time of coronary angiography and reduces the time necessary to localise graft ostium, the total procedure time, and volume of contrast media used.

Transradial Versus Transfemoral Approach for Coronary Angiography in Females with Prior Bypass Surgery.

BackgroundMultiple studies have shown that trans-radial access (TRA) for women undergoing coronary angiography/intervention (CA/I) has a lower risk of vascular access site complications as compared with trans-femoral access (TFA). In patients who had previously undergone coronary artery bypass grafting (CABG), studies also showed no significant difference between TRA and TFA in terms of contrast amount (CA), procedure time (PT), and fluoroscopy time (FT). However, those studies mainly included men. Limited information is available on the relative merits of TRA as compared with TFA for cardiac catheterization in females who previously undergone CABG. The purpose of this study was to determine the efficacy and safety of TRA versus TFA in women with prior CABG surgery who are undergoing CA/I in regard to CA, PT, and FT.MethodsIn this single-center retrospective cohort study, females with a history of CABG who underwent CA/I in the period from January 2013 to September 2016 were included. A total of 584 patients were included and divided into two groups: TRA group (49 patients) and TFA group (535 patients). The primary endpoints were CA, PT, and FT. The means for the primary outcomes were compared between the two using the independent t-score test.ResultsA total of 584 female patients with a history of CABG had cardiac catheterization from January 2013 to September 2016 at our center. Trans-femoral access accounted for 91.6% (n=535) of the patients while trans-radial access accounted for 8.4% (n=49) of the patients. A comparison of procedural variables between TRA and TFA revealed that there was no statistical significance in procedure time, fluoroscopy time, or the contrast volume. The access site crossover rate was 6.12% (n=3) from radial to femoral while there was a 0% rate in the femoral to radial access.ConclusionThe key findings of this study suggest that in female patients with a prior history of CABG, TRA is an equally reliable and efficacious approach for both diagnostic angiography and intervention compared to TFA.

Feasibility and safety of orbital atherectomy for the treatment of in-stent restenosis secondary to stent under-expansion.

Debulking and ablative techniques are sometimes used for the treatment of in-stent restenosis (ISR) secondary to resistant stent under-expansion (SU). The safety and effectiveness of orbital atherectomy (OA) in this cohort of patients has not been reported. We retrospectively evaluated consecutive patients treated with OA for ISR secondary to balloon undilatable SU at two academic tertiary care centers between October 2016 and June 2019. Angiographic or intravascular imaging identified SU. Technical success was defined as residual 0% stenosis with TIMI III flow. A total of 41 patients were included in the study. Patients had an average age of 65 ± 12 years; 73% male, 61% diabetic, 41% with prior coronary artery bypass grafting, 61% with a prior incident of ISR, 51% presented with stable angina, 17% unstable angina, and 32% non-ST elevation myocardial infarction (MI). Implantation of the under-expanded stents occurred between 2 months and 22 years prior to the index procedure. A total of 27% of patients had multiple layers of stents in the target lesion and 32% of patients had in-stent chronic total occlusion. Technical success was achieved in 40 (98%) patients. There were 2 (5%) major adverse cardiovascular events; both of them were periprocedural MI from the no-reflow phenomenon. There were 2 (5%) Ellis type II coronary perforations that required no intervention. OA can be effectively performed as an adjunctive tool in the treatment of ISR with balloon undilatable SU. The use of OA for SU is not approved by the U.S. Food and Drug Administration and is "off label" and caution must be used to limit any device/stent interaction.

Outcomes of Transradial Approach to Percutaneous Coronary Intervention in End-Stage Renal Disease Patients on Dialysis

BackgroundPercutaneous coronary intervention (PCI) is increasingly performed in patients with chronic kidney disease (CKD), including in end-stage renal disease (ESRD), however studies on vascular access are limited. ObjectiveWe sought to describe vascular access choice and outcomes of PCI from transfemoral (TFA) compared to transradial access (TRA) in ESRD patients on dialysis. MethodsPatients with ESRD on dialysis undergoing PCI from October 2010 to January 2017 at two hospitals in a health system reporting to the National Cardiovascular Data Registry (NCDR) CathPCI registry as well as their respective electronic medical records (Epic) were analyzed. Baseline characteristics, procedural and in-hospital outcomes were compared according to access site, TFA versus TRA. ResultsThere were 270 patients with ESRD on dialysis who underwent PCI, 234 via the TFA and 36 via the TRA. Mean age of the patients was 67 and 67.4% were male. The TFA patients had a lower body-mass-index (BMI) (P < 0.001) and were more likely to have prior coronary artery bypass graft (CABG) (P < 0.001) and PCI of the left main coronary artery (LM) (P = 0.04). Access site cross over only occurred in one patient in each group. Bleeding within 72 h was seen in 3.8% of the TFA group and in 2.8% of the TRA group (P = 0.75). ConclusionUse of TRA is uncommon in patients with ESRD on dialysis, but is feasible and associated with low complication rates, similar to TF. Summary for the annotated table of contentsWhile PCI is being increasingly performed in patients with end-stage renal disease, there are is a lack of data on vascular access for this group. This study shows that while a transradial approach TRA is less common than transfemoral (TFA), it is still a feasible option and is associated with low complications similar to TFA.

Trends in Usage and Clinical Outcomes of Coronary Atherectomy: A Report From the National Cardiovascular Data Registry CathPCI Registry.

Adjunctive coronary atherectomy (CA) can be utilized in treating severely calcified coronary lesions; however, the temporal trends, patient selection, and variation in use of CA have not been well described. We sought to assess the trends in usage, interhospital variability, and outcomes with CA among patients undergoing percutaneous coronary intervention (PCI). All patients undergoing PCI in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009 to December 31, 2016 (N=3 864 377) were analyzed based on utilization of either rotational or orbital CA. Intervals using date of index CA grouped into 2009 Q3 to 2010, 2011 to 2012, 2013 to 2014, and 2015 to 2016 and hospital-level quartiles based on annual CA volumes were evaluated. The primary outcome measure was in-hospital major adverse cardiac events defined as a composite of all-cause mortality, periprocedural myocardial infarction, or stroke. Independent variables associated with outcomes were determined. CA represented 1.7% (n=65 033) of the total PCI volume. Among hospitals performing PCI (n=1672), 577 (34.5%) did not perform any CA. Patients treated with CA were elderly, more often male, and had a history of diabetes, prior myocardial infarction, PCI, and coronary artery bypass grafting. The utilization of CA increased from 1.1% in Q3 2009 to 3.0% in Q4 of 2016 (5% quarterly increase in odds of CA; OR [95% CI], 1.05 [1.04-1.06], P<0.001). Among patients undergoing CA, there was a temporal decline in major adverse cardiac events (0.98 [0.97-0.99], P<0.001) and myocardial infarction (0.97 [0.96-0.98], P<0.001). In adjusted analyses, increasing hospital CA volume was associated with lower mortality (0.85 [0.76-0.96], P=0.01) and lower rates of PCI failure or complication requiring coronary artery bypass grafting (0.67 [0.56-0.79], P<0.001) but was associated with small increase in coronary perforation (1.18 [1.04-1.35], P<0.01). Although CA is performed infrequently, its use has increased over time. After accounting for potential confounders, higher CA volume was associated with lower risk of major adverse events counterbalanced by small risk of coronary perforation.

A024 Coronary Angiography and Percutaneous Coronary Intervention After Acute Coronary Syndrome in Patients With Prior CABG – A National Audit using ANZACS-QI

Coronary angiography (CA) in patients with previous coronary artery bypass grafts (CABG) is technically more difficult and has been linked to higher in-hospital complications and mortality. Our aim is to describe the characteristics, coronary angiography findings and percutaneous coronary interventional (PCI) management in patients with prior CABG undergoing coronary angiography post-ACS. The All NZ Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry was used to identify patients admitted to NZ public hospitals with a first ACS event who underwent invasive CA between September 2014 and December 2018. We compared ACS patients with and without with prior CABG. Of 57,357 ACS patients, 3,573 (6%) had prior CABG. Patients with prior CABG were older than those without CABG (71y vs. 65y, p<0.01) and more likely to be male (82% vs. 66%, p<0.01). The use of radial artery access for CA was lower in those with prior CABG than for those without prior CABG (50% vs. 89%, p<0.01). PCI use was similar in both groups (35% vs. 36%, p=0.04). Of the 1264 patients with prior CABG who were treated with PCI, 64% had PCI to the native coronary artery only, 31% had PCI to a coronary graft, and 61 (5%) had PCI to both native vessel and graft. Half of patients with prior CABG were studied via the radial artery route. A third of patients with prior CABG received a PCI, a rate similar to those without prior CABG, and of these, two-thirds received intervention to a native coronary artery.