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Coronary artery bypass grafting in patients after failure of intracoronary stenting
J M Craver1, A G Justicz, W S Weintraub
1Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Coronary artery bypass grafting after stent placement is a successful treatment for failed stents. Prompt surgical revascularization offers excellent long-term survival despite a substantial rate of Q-wave myocardial infarction.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Intracoronary stents are utilized for acute/threatened closure post-percutaneous transluminal coronary angioplasty (PTCA) and to prevent restenosis.
- Stent failure necessitating coronary artery bypass grafting (CABG) is a recognized complication.
Purpose of the Study:
- To review outcomes of patients undergoing CABG after stent placement.
- To identify factors influencing procedural success and long-term mortality.
Main Methods:
- Retrospective review of 68 patients who underwent CABG after coronary stent placement.
- Analysis of patient demographics, clinical characteristics, and procedural urgency.
- Evaluation of in-hospital outcomes, including mortality, myocardial infarction, and stroke.
- Assessment of long-term mortality correlates.
Main Results:
- No correlation found between procedural urgency, prior infarction, or prior CABG and successful procedure.
- In-hospital mortality was 4.4%, with 21% experiencing Q-wave myocardial infarction and 1.5% suffering a stroke.
- Ejection fraction was identified as the sole correlate of long-term mortality.
Conclusions:
- CABG is a successful treatment for coronary artery injury resulting in stent failure.
- Prompt surgical revascularization leads to excellent long-term survival and event rates.
- The rate of Q-wave myocardial infarction is significant and linked to the initial ischemic insult.
Background:
Intracoronary stents are being used to treat acute and threatened closure after percutaneous transluminal coronary angioplasty and to prevent restenosis.
Methods:
The outcomes of 68 patients having coronary artery bypass grafting after stent placement were reviewed. The mean age was 60.5 +/- 9.7 years, and 71% were male. Thirty-seven percent had hypertension, 13% had diabetes, 62% had class III or IV angina, 60% had multivessel disease, and 40% had sustained a prior myocardial infarction. Fifty-three patients underwent emergency operation, 22 with hemodynamic collapse immediately after percutaneous transluminal coronary angioplasty, and 7 others required urgent revascularization within 24 hours of angioplasty. Seventeen underwent coronary artery bypass grafting for acute closure of the stented vessel several days after the angioplasty procedure.
Results:
There was no correlation between urgency of the procedure, previous infarction, or previous coronary artery bypass grafting with successful procedure. The in-hospital mortality was 4.4%, 21% had a Q-wave myocardial infarction, and 1.5% sustained a stroke. Ejection fraction was the only correlate of long-term mortality.
Conclusions:
Coronary artery injury for which stents are placed for acute or threatened occlusion or to prevent restenosis but then fail, thus necessitating coronary artery bypass grafting, can be treated successfully. Although the rate of Q-wave myocardial infarction is substantial and related to the initial ischemic insult, the long-term survival and event rates are excellent with prompt surgical revascularization.