Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: A multicenter analysis

Abstract

Multicenter analysis confirms that a history of multiple previous percutaneous coronary interventions increases in-hospital mortality and the incidence of major adverse cardiac events after subsequent coronary artery bypass grafting. Critical discussion of the treatment strategy in these patients is warranted.

Intervenção Coronariana Percutânea prévia como fator de risco para Revascularização Miocárdica

“…As consequence, there are an increasing number of patients who have been submitted to PCI with stents before being finally referred for CABG. In the literature, this incidence ranges from 10% to 20% [8][9][10] . From our study group, 161 patients (14.6%) had previous PCI.…”

“…Some studies have shown restenosis rates after PCI with stent, with need of reintervention due to symptom recurrence, ranging from 20% to 40% 6,7 . More recently, it has been discussed whether previous PCI is a risk factor with negative impact on the outcomes of CABG [8][9][10] . A significant inflammatory process and endothelial function abnormalities in the coronary arteries have been related to the treatment with stent, especially when drug-eluting stents were used [11][12][13] .…”

Impact of previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting

“…Importantly, in the study of Lisboa et al previous PCI emerged as an independent predictor of in-hospital mortality as strong as diabetes [7]. Some of the studies also indicate that multiple PCIs are stronger predictor of the above-mentioned clinical endpoints compared to single previous PCI or no prior PCI [11,12]. Except for the impact of prior PCI on perioperative mortality, Bonaros et al reported higher perioperative morbidity (MACE, bleeding complications, acute renal failure, renal replacement therapy and the use of blood products) as well [6].…”

“…Although, there is a large body of evidence indicating that previous PCI adversely affects clinical outcomes of CABG, this is not supported by other published data [5,6,7,8,9,10]. Some studies reported that patients with multiple PCI procedures have significantly increased risk for in-hospital mortality and major adverse cardiac events (MACE) compared with patients without or with only a single previous PCI [11,12].…”

Conduit Selection for Improved Outcomes in Coronary Artery Bypass Surgery

“…Consequently, contemporary results for CABG following PCI are characterized by worse perioperative outcomes when compared with CABG patients without previous intervention. For example, higher rates of postoperative mortality, MACE, and other perioperative complications following CABG in both diabetic and nondiabetic patients have been observed [47][48][49][50]. More importantly, increased mid-term mortality in diabetic patients with prior PCI has been observed after CABG [50], and Rao et al demonstrated increased long-term mortality in patients with prior PCI who subsequently underwent CABG [51].…”