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Updated: Jul 15, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary Artery Bypass Graft Surgery After Primary Percutaneous Coronary Intervention in Patients With ST-Elevation
Jamshid Bagheri1, Mana Jameie2, Zahra Dehghani Saryazdi2
1Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Primary percutaneous coronary intervention (PPCI) before coronary artery bypass graft (CABG) for ST-elevation myocardial infarction (STEMI) did not increase in-hospital mortality, length of stay, or bleeding. However, complicated PPCI cases showed increased mortality risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
- Coronary artery bypass graft (CABG) surgery is a treatment option for complex coronary artery disease.
- The role of primary percutaneous coronary intervention (PPCI) prior to CABG in STEMI patients remains a subject of investigation.
Purpose of the Study:
- To evaluate the association between PPCI and adverse outcomes in STEMI patients undergoing CABG.
- To compare in-hospital mortality, length of stay, and bleeding events between PPCI+CABG and CABG-only groups.
Main Methods:
- Retrospective analysis of 354 STEMI patients undergoing CABG between September 2015 and November 2020.
- Comparison of 222 patients who received PPCI before CABG (PPCI+CABG) with those who had CABG only.
- Stabilised inverse probability weighting (S-IPW) method used to adjust for baseline differences and analyze primary endpoints.
Main Results:
- Overall, PPCI prior to CABG was not significantly associated with increased in-hospital mortality (S-IPW OR 0.61, p=0.393), length of stay (S-IPW β -0.050, p=0.403), or bleeding events (S-IPW OR 1.06, p=0.821).
- The PPCI+CABG group had 3.6% mortality and 55.9% bleeding events; the CABG-only group had 4.5% mortality and 50.8% bleeding.
- Unadjusted analysis revealed significantly higher mortality risk in complicated PPCI subgroups compared to CABG-only (OR 7.50).
Conclusions:
- PPCI does not appear to confer additional risk for in-hospital mortality, length of stay, or bleeding in STEMI patients undergoing CABG.
- Certain PPCI subgroups, particularly those with complicated procedures, are associated with an elevated risk of mortality.
- Further research into specific PPCI strategies and patient selection for combined PCI-CABG in STEMI is warranted.
Objective:
To determine whether primary percutaneous coronary intervention (PPCI) is associated with adverse outcomes following coronary artery bypass graft (CABG) among patients with ST-elevation myocardial infarction (STEMI).
Methods:
Patients presenting with acute STEMI who underwent CABG between September 2015 and November 2020 were included. Among 354 patients, 222 (62.7%) underwent PPCI prior to CABG (PPCI+CABG group) and were compared with the rest of the patients (CABG only group). The effects of PPCI on primary endpoints---including in-hospital mortality, length of stay (LOS), and bleeding events---were investigated using the stabilised inverse probability weighting method (S-IPW). Further, in-hospital mortality in various PPCI subgroups was analysed using univariable regression.
Results:
Patients with and without PPCI were comparable regarding their baseline and surgical characteristics, except that those without PPCI were more likely to have left-main disease (29.5% vs 16.2%, p-value=0.003). Among the PPCI+CABG group, 3.6% mortality and 55.9% bleeding events occurred, and the LOS was 7 [5-10] days. The respective figures for the CABG only group were 4.5%, 50.8%, and 7 [6-10.5] days. Primary percutaneous coronary intervention, as a whole, was not significantly associated with either morality (S-IPW odds ratio (S-IPW OR) 0.61; p=0.393), LOS logarithm (S-IPW β -0.050; p=0.403), or bleeding events (S-IPW OR 1.06; p=0.821). Nevertheless, the unadjusted mortality risk was significantly higher in complicated PPCIs compared with the CABG only group (OR 7.50, 95% CI 2.03-27.77); it was also higher among some other PPCI subgroups, albeit non-significantly.
Conclusion:
This study found that PPCI did not confer additional risk regarding in-hospital mortality, LOS, or bleeding among patients with acute STEMI who underwent CABG. However, some PPCI subgroups, especially those with complicated PPCI, were at increased risk.
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