Percutaneous coronary interventions in patients with a previous coronary artery bypass graft surgery

Coronary artery bypass grafting (CABG) remains the gold standard for revascularization in patients with complex coronary artery disease (CAD), especially those with diabetes mellitus. However, graft failure and progressive native CAD frequently requires repeat revascularization. While percutaneous coronary intervention (PCI) is the most employed secondary strategy, evidence guiding best practice remains limited. This doctorate investigates PCI in patients with prior CABG, examining target vessel selection, procedural characteristics, antithrombotic strategies, and outcomes. We first conducted a literature review of CABG and PCI management in this population. Subsequently, using U.S. registry data, we evaluated clinical outcomes by gender and ethnicity, revealing comparable outcomes post-PCI across groups. A large single-center study in New York and a nationwide registry in the Netherlands assessed outcomes based on PCI target vessels, including native arteries, venous, and arterial grafts, and highlighted the differences in procedural risks and clinical outcomes. Finally, we examined antiplatelet therapy strategies using data from the TWILIGHT trial, showing ticagrelor monotherapy reduced bleeding without compromising ischemic protection in prior CABG patients. Overall, this thesis underscores the heterogeneity and complexity of PCI in prior CABG patients, calls for tailored treatment strategies, and highlights the need for randomized trials to optimize care in this growing yet understudied population.