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Published on: March 27, 2018
Follow-Up and Outcome after Coronary Bypass Surgery Preceded by Coronary Stent Implantation
Marwan Hamiko1, Nicole Konrad1, Doreen Lagemann1
1Department of Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany.
Insights
Prior percutaneous coronary intervention (PCI) before coronary artery bypass graft (CABG) surgery is linked to worse outcomes and quality of life. Guideline-conformant PCI improved results, influencing Heart Team decisions for stable coronary artery disease patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Guidelines recommend percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) for myocardial revascularization.
- Limited data exists on long-term outcomes and quality of life (QoL) after CABG following prior PCI.
Purpose of the Study:
- To assess the impact of prior PCI on the outcomes and QoL of patients undergoing CABG for stable coronary artery disease.
Main Methods:
- Retrospective analysis of 997 CABG patients, divided into PCI-first (PCF) and CABG-only (CO) groups.
- PCF group further stratified into guideline-conform (GCO) and guideline nonconform (GNC) subgroups based on SYNTAX score (2014 ESC/EACTS guidelines).
- Evaluated 30-day mortality, major adverse cardiac events, and QoL using the European Quality-of-Life-5 Dimensions.
Main Results:
- PCI-first patients (n=213) showed higher rates of reinfarction, re-angiography, and re-PCI compared to CABG-only patients (n=784).
- PCI-first patients reported worse health status (68.20 vs. 72.48) and higher rehospitalization rates.
- Guideline nonconform patients experienced poorer health status and required more re-PCI procedures than guideline-conform patients.
Conclusions:
- PCI preceding CABG is associated with adverse outcomes and diminished QoL, especially when not guideline-conformant.
- Guideline-conformant PCI in the PCI-first group demonstrated better outcomes.
- Findings emphasize the importance of adhering to guidelines for PCI before CABG to optimize patient management and decision-making.
Background:
Guidelines on myocardial revascularization define recommendations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Only little information exists on long-term follow-up and quality of life (QoL) after CABG preceded by PCI. The aim of our study was to evaluate the impact of prior PCI on outcome and QoL in patients with stable coronary artery disease who underwent CABG.
Methods:
In our retrospective study, CABG patients were divided in: CABG preceded by PCI: PCI-first (PCF), and CABG-only (CO) groups. The PCF group was further divided in guideline-conform (GCO) and guideline nonconform (GNC) subgroups, according to the SYNTAX score (2014 European Society of Cardiology [ESC]/European Association for Cardio-Thoracic Surgery [EACTS] guidelines). Thirty days mortality, major adverse cardiac events, and QoL using the European Quality-of-Life-5 Dimensions were evaluated.
Results:
A total of 997 patients were analyzed, of which 784 underwent CABG without (CO), and 213 individuals with prior PCI (PCF). The latter group consisted of 67 patients being treated in accordance (GCO), and 24 in discordance (GNC) to the 2014 ESC/EACTS guidelines. Reinfarction (PCF: 3.8% vs. CO: 1.0%; p = 0.024), re-angiography (PCF: 17.6% vs. CO: 9.0%; p = 0.004), and re-PCI (PCF: 10.4% vs. CO: 3.0%; p < 0.001) were observed more frequently in PCF patients. Also, patients reported better health status in the CO compared to PCF group (CO: 72.48 ± 19.31 vs. PCF: 68.20 ± 17.86; p = 0.01). Patients from the guideline nonconform subgroup reported poorer health status compared to the guideline-conform group (GNC: 64.23 ± 14.56 vs. GCO: 73.42 ± 17.66; p = 0.041) and were more likely to require re-PCI (GNC: 18.8% vs. GCO: 2.4%; p = 0.03). Also, GNC patients were more likely to have left main stenosis (GCO: 19.7% vs. GNC: 37.5%; p < 0.001) and showed higher preinterventional SYNTAX score (GCO: 18.63 ± 9.81 vs. GNC: 26.67 ± 5.07; p < 0.001).
Conclusion:
PCI preceding CABG is associated with poorer outcomes such as reinfarction, re-angiography, and re-PCI, but also worse health status and higher rehospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart Team decision.
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