[Coronary artery bypass grafting in patients following percutaneous coronary interventions]

To investigate and analyze the clinical outcomes of coronary artery bypass grafting (CABG) in patients with history of previous percutaneous coronary interventions (PCI).

We studied 76 patients with a history of PCI who underwent CABG surgery in our institute from August of 1999 to April of 2002, which was 14.0 percent of concurrent CABG. There were 39 cases with PTCA alone and 37 combined with stent implantation, of whom 5 had undergone re-do PCI therapy. Then 46 patients encountered re-stenosis and 6 developed new lesion in native coronary arteries. There were 4 cases with unsuccessful PCI, 11 cases with residual lesion in important vessels and 9 cases with acute complications during PCI. There was a higher incidence of myocardial infarction in group PCI than that in group Non-PCI, and a lower incidence of triple vessel disease (P<0.01).

Group PCI had more emergent surgeries (27.6% vs 13.3%) and fewer OPCAB procedures (91.3% vs 97.2%) than group Non-PCI (P<0.01). The mean number of distal anastomosis in group PCI was smaller than that in group Non-PCI (P<0.01). There were 6 people who died in group PCI, of whom 3 died of heart pump failure,1 of ventricular fibrillation, 1 of neurological complication, and 1 of renal failure. The mortality of group PCI was higher than group Non-PCI (7.9% vs 1.9%, P<0.01). In group PCI, there were 4 with peri-operative myocardial infarction, 1 with late death and 1 with recurrent angina pectoris.

CABG is usually the most effective and necessary way to treat PCI failure, unsatisfactory revascularization and its acute complications. It is most important to promptly and appropriately deal with acute complications of PCI in reducing the mortality.