Surgical Outcome of Coronary Artery Bypass Graft in Patients with Previous Coronary Stenting

Abstract

Background: With the advancement of percutaneous coronary interventions, patients are presenting to coronary artery bypass grafting (CABG) older, with several co-morbidities and with prior coronary stenting. The outcome of surgery after stenting continues to be debated. We evaluated the surgical outcome of coronary artery bypass grafting in patients with previous coronary stenting. Material and Methods: This prospective cohort study included 50 patients with previous coronary stent who underwent CABG between February 2016 and June 2017. Thirty-eight patients were males (76%), and the mean age was 57.66±8.81 years. The mean ejection fraction was 41.43±9.25%. Forty-six patients (92%) had previous one stent, and 4 patients (8%) had 2 stents. Results: Nineteen patients had in-stent restenosis (38%), and 31 patients had new lesions (62%). Seven patients had lesions distal to the site of the stent (14%).The mean cardiopulmonary bypass time was 102.66±25.34 minutes. Two patients needed an intraoperative intra-aortic pump and four in the ICU. Five patients (10%) developed acute myocardial infarction. Operative mortality occurred in 4 patients (8%); one patient (2%) had an acute renal failure. Ejection fraction at 6 months postdischarge showed an increase compared to the preoperative value (41.43±9.25%-44.78±6.99%, P= 0.013).Mortality occurred more frequently in patients with IABP and in patients who had MI and renal failure. Mortality was not associated with in-stent stenosis. Conclusions: Coronary artery bypass grafting in patients with prior coronary stenting could be associated with increased morbidity and mortality. Proper management of coronary artery disease is essential to decrease the risk of future intervention.