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Repeated Target Vessel Revascularization After Coronary Artery Bypass for In-Stent Restenosis
Jung-Hwan Kim1, Seung Hyun Lee1, Hyun-Chel Joo1
1Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea.
Insights
Previous stenting before off-pump coronary artery bypass grafting (OPCAB) does not impact long-term survival. However, it increases the risk of target vessel revascularization (TVR) and major adverse cardiac and cerebrovascular events (MACCEs) if in-stent restenosis is present.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Off-pump coronary artery bypass grafting (OPCAB) is a common procedure for treating triple-vessel disease.
- The impact of prior percutaneous coronary intervention with stent (PCI-S) on long-term outcomes after OPCAB is not fully understood.
Purpose of the Study:
- To evaluate the long-term effects of previous PCI-S on outcomes in patients undergoing OPCAB.
- To identify risk factors for adverse events after OPCAB in patients with a history of PCI-S.
Main Methods:
- A retrospective review of 1,668 patients with triple-vessel disease undergoing OPCAB between 2001 and 2014.
- Patients were divided into a no-stent group (primary revascularization) and a stent group (prior PCI-S).
- Propensity score matching was used to ensure group comparability, with a mean follow-up of 5.32 years.
Main Results:
- In-hospital mortality and 14-year overall survival rates were similar between the no-stent and stent groups.
- Freedom from major adverse cardiac and cerebrovascular events (MACCEs) at 14 years was also comparable.
- However, freedom from target vessel revascularization (TVR) was significantly lower in the stent group (76.9%) compared to the no-stent group (97.2%).
Conclusions:
- Previous PCI-S does not adversely affect long-term mortality or MACCEs after OPCAB.
- Grafting to previously stented vessels with in-stent restenosis significantly increases the risk of late TVR and MACCEs.
- In-stent restenosis is an independent risk factor for both late TVR and MACCEs following OPCAB.
Background:
The purpose of this study was to examine the impact of previous percutaneous coronary intervention with stent on long-term outcomes after off-pump coronary artery bypass grafting (OPCAB).
Methods:
Between January 2001 and December 2014, 1,668 patients with triple-vessel disease undergoing OPCAB were reviewed and divided into 2 groups. The no-stent group (n = 1,409) included patients who underwent OPCAB as a primary revascularization procedure and the stent group (n = 259) included patients with a history of percutaneous coronary intervention with stent. The mean follow-up duration was 5.32 ± 3.39 years.
Results:
After propensity score matching, characteristics of both groups were comparable (n = 259 in each group). In-hospital mortality (n = 3 [1.2%] in both groups; p > 0.999) was similar. The 14-year overall survival rate (75.6% ± 6.6% in the no-stent group versus 71.9% ± 8.5% in the stent group; p = 0.917) and freedom from major adverse cardiac and cerebrovascular events (MACCEs) rate (68.3% ± 6.6% versus 54.6% ± 8.5%; p = 0.239) were also similar. However, freedom from target vessel revascularization (TVR) rate at 14 years was significantly higher in the no-stent group (97.2% ± 1.7% versus 76.9% ± 6.5%; p < 0.001). The independent risk factor for late TVR was in-stent restenosis (hazard ratio, 3.355; 95% confidence interval, 1.925 to 5.848; p < 0.001) and it also was a risk factor for MACCEs (hazard ratio, 1.645; 95% CI, 1.105 to 2.448; p = 0.014).
Conclusions:
Previous intracoronary stenting does not increase long-term mortality, but grafting to previously stented target vessels with in-stent restenosis increases the risk of repeat TVR and MACCEs.