THE EFFECT OF UNDERGONE BYPASS SURGERY ON THE PERCUTANEOUS CORONARY INTERVENTION RESULTS/DOES PREVIOUS CORONARY ARTERY BYPASS SURGERY COMPLICATE THE SUBSEQUENT PERCUTANEOUS CORONARY INTERVENTION?

Abstract

Background : Recurrent revascularization is frequently needed in despite to the modern treatment options of coronary artery disease. Recurrent revascularization has need special caution in the setting of previous coronary bypass surgery (CABG). There is no study to investigate possible adverse effects of prior CABG on percutaneous coronary interventions (PCI). This study investigated that PCI results of the patients with prior CABG. Methods: Patients who underwent PCI screened retrospectively. Consecutive 100 patients had been prior PCI (group 1), and 100 patients had been prior CABG (group 2) were enrolled to the study. The patients were not enrolled in the study; index PCI underwent bypass graft or total occluded lesion or instant lesion or in the setting of ST elevation myocardial infarction or bifurcation stenting was done. Results: Group 1 and group 2 were similar in terms of age and gender. No statistically significant difference was observed between other demographic features. The lesion severity was not significantly different between the groups. In the CABG group, the intervention was more frequent to the Cx lesion; while in the PCI group, intervention to the LAD lesion was more frequent. Factors that made the procedure difficult were similar in both groups . There was no significant difference between the two groups regarding lesions longer than 20 mm and diffuse coronary artery disease. Balloon and stenting were more frequent in the CABG group, and direct stenting was more frequent in the PCI group (p<0.05) Balloon dilatation was found to be more frequent in the CABG group. The duration of the procedure, number of angiographic frames and films, amount of contrast material used were significantly higher in the CABG group, as the difference between the two groups was not significant regarding balloon pressures applied during stenting . Previous CABG history was found to be an independent variable for the duration of the procedure and the number of angiographic frames. Prior CABG also has a significant correlation with prolonged intervention duration, radiopaque volume, and cine-angiography film and frame counts when controlling for intervened artery and prior index intervention time interval. Conclusions: PCI was associated with prolonged intervention duration, higher radiopaque volume and higher radiation exposure when implanted in patients with prior CABG. The physician should be alert and precautionary for more complex PCI in patients with prior CABG.