PROCTOR Compares Bypass Graft PCI Versus Native Vessel PCI After CABG

November 24, 2025—Results from the randomized PROCTOR trial demonstrated that percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) led to significantly better 1-year clinical outcomes than PCI of native coronary arteries in patients with previous coronary artery bypass grafting (CABG).

The PROCTOR findings were presented at TCT 2025 and published simultaneously by Ruben W. de Winter, MD, et al in the Journal of the American College of Cardiology.

As summarized in the TCT press release, 220 post-CABG patients with significant SVG stenosis were enrolled at 14 centers in Europe from January 2019 through December 2023. The patients were randomized 1:1 to undergo either native vessel PCI (n = 108) or SVG PCI (n = 112).

The press release reported that the primary endpoint major adverse cardiac events (MACE) at 1 year occurred in 37 patients (34.3%) in the native vessel group compared with 21 (18.7%) in the SVG group (hazard ratio [HR], 2.14; 95% CI, 1.25-3.65; log-rank P = .004). MACE was defined as all-cause mortality, nonfatal target coronary territory myocardial infarction (MI), and clinically driven target coronary territory revascularization.

Rates of all-cause mortality did not differ significantly between groups (5.6% native vessel vs 3.6% SVG; HR, 1.59; 95% CI, 0.45-5.64; P = .468). However, both nonfatal target coronary territory MI (22.6% vs 11.7%; HR, 2.12; 95% CI, 1.08-4.17; P = .024) and clinically driven target coronary territory revascularization (18.4% vs 9.1%; HR, 2.19; 95% CI, 1.02-4.72; P = .039) occurred more frequently after native vessel PCI.

“Our study demonstrated that SVG PCI in the high-risk and complex post-CABG patient population led to improved 1-year clinical outcomes compared with native vessel PCI,” commented Dr. de Winter, principal investigator of the study, in the TCT press release. “Mainly due to fewer PCI-related MIs and clinically driven target coronary territory revascularization, these results challenge current guidelines at 1-year clinical follow-up, and long-term data will show if this early advantage continues over time.”

The investigators advised that ongoing follow-up will assess whether the early benefit of SVG PCI is sustained and whether these findings warrant reconsideration of current revascularization recommendations for post-CABG patients presenting with graft failure, noted the TCT press release.