# Etiology of Coronary Reintervention After Coronary Artery Bypass Surgery

## TL;DR

This study finds that about 9% of patients who had heart bypass surgery needed further treatment due to graft failure or disease progression, but survival rates were similar to those who didn't need more treatment.

## Contribution

The study identifies graft failure as the main cause of reintervention after CABG and highlights risk factors like diabetes and single arterial grafts.

## Key findings

- Graft failure was the most common cause of reintervention (64.6%).
- Diabetes and single arterial grafts were significant risk factors for reintervention.
- Mortality rates were similar between patients who had reintervention and those who did not.

## Abstract

(1) Background: Coronary artery bypass grafting (CABG) reduces the risk of target vessel revascularization compared to percutaneous coronary intervention (PCI), yet coronary reintervention may still occur. This study aims to evaluate the incidence and underlying etiology of reintervention after CABG. (2) Methods: A single-center retrospective cohort study of all patients undergoing isolated CABG (January 2016–December 2021) was performed. Surgical or percutaneous reinterventions were analyzed until December 2022 using institutional data linked to the Netherlands Heart Registration (NHR) and chart review. (3) Results: Amongst 4814 patients, 8.7% (n = 418) underwent coronary reintervention during a median 4.5 [3.8–4.8] year follow-up. Causes of reintervention included graft failure (64.6%), progression of coronary artery disease (20.3%), incomplete revascularization (10.5%), or combined factors (4.1%). Mortality did not differ significantly between reintervention and non-reintervention groups (10.8% vs. 7.9%, p = 0.095). Multivariable analysis identified diabetes (HR 1.02, 95% CI 1.00–1.04, p = 0.011), single arterial graft (HR 2.26, 95% CI 1.31–3.91, p = 0.003), and ventilation > 24 h (HR 4.61, 95% CI 1.85–11.51, p = 0.001) as independent risk factors for coronary reintervention. (4) Conclusions: After CABG, 8.7% of patients underwent coronary reintervention at mid-term follow-up. Graft failure was the predominant etiology, followed by coronary artery disease progression. Overall survival did not differ between patients with or without reintervention.