Abstract
Introduction: Approximately 15 to 30% of patients undergoing percutaneous coronary intervention (PCI) will require repeated revascularization. There is an ongoing debate concerning the impact of prior PCI on subsequent coronary artery bypass graft (CABG) surgery. This study sought to compare immediate post-CABG complications between patients with and without previous coronary stenting. Methods: A total of 556 CABG candidates including 73 patients with previous coronary stenting and 483 patients without prior stenting were enrolled in this retrospective-prospective study. Demographic information, cardiac markers (CK-MB, Troponin T), and postoperative data including inotrope administration, intra-aortic balloon pump (IABP) use, bleeding, pathological electrocardiography (ECG) changes, and overall complications were compared between the two groups. Results: The mean age of the patients in stented group was significantly higher than that in unstented group (63.49±7.71 vs. 61.37±9.80 years, p=0.05). The mean serum level of Troponin T 12 h postoperation was significantly higher in the same group (323.26±33.16 vs. 243.30±11.52 ng/dL; p=0.03). Comparing the stented and unstented groups, the rates of inotrope use (17.8% vs. 7.2%; p=0.003), significant bleeding (15.1% vs. 4.3%; p=0.001), and overall complications (32.9% vs. 11.6%; odds ratio: 3.74 with 95% confidence interval of 2.13-6.55, p<0.001) were significantly higher in the former group. The association between overall complications and prior stenting was independent (odd ratio: 3.06). No significant connections were found between postoperative complications and stent number or type. Conclusion: A positive history of previous coronary stenting significantly increases the risk of immediate post-CABG complications.
Highlights
15 to 30% of patients undergoing percutaneous coronary intervention (PCI) will require repeated revascularization
Evolving from straightforward balloon angioplasty of a single coronary stenosis to sophisticated multivessel stenting with employment of drug-eluting stents (DES), cutting-edge instruments, and advanced techniques,[3] PCI is ubiquitous and performed more commonly than in the past.[4]
The two groups were comparable for sex (Chi-square test p=0.78), mean preoperative left ventricular ejection fraction (LVEF), history of diabetes mellitus (Chi-square test p=0.99), men serum levels of CK-MB 6 h and 12 h postoperation, mean serum level of Troponin T 6 h postoperation, postoperative intra-aortic balloon pump (IABP) (Fisher’s exact test p=0.17), and postoperative pathological ECG change(s) (Fisher’s exact test p=0.43)
Summary
15 to 30% of patients undergoing percutaneous coronary intervention (PCI) will require repeated revascularization. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two principal recourses for patients with CAD.[1, 2] Evolving from straightforward balloon angioplasty of a single coronary stenosis to sophisticated multivessel stenting with employment of drug-eluting stents (DES), cutting-edge instruments, and advanced techniques,[3] PCI is ubiquitous and performed more commonly than in the past.[4] In the Western countries the ratio of PCI to CABG is currently estimated to be over four to one.[5] Despite this enthusiastic inclination toward PCI, it is well known that in comparison with CABG, PCI is along with higher rates of failure.[6] In a study by Abbott et al[7] the oneyear rate of target-vessel revascularization was 5% for DES and over 9% for bare-metal stents This high rate of PCI shortcoming, and at the same time, with the number of stented patients on the rise, frequent encounters with CABG candidates with prior PCI(s) in the current practice is not a surprise anymore.[8,9] Influences of preceding PCI(s) on CABG outcomes, have been not investigated adequately,[10] and available reports in the literature are sometime contentious.[11,12,13,14,15] This study sought to examine the effect of prior coronary artery stenting(s) on immediate postoperative outcome of CABG surgery
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