Download PDF
CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2024; 72(06): 423-434
DOI: 10.1055/a-2107-0481
Original Cardiovascular

Follow-Up and Outcome after Coronary Bypass Surgery Preceded by Coronary Stent Implantation

Marwan Hamiko   *
1   Department of Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Nicole Konrad   *
1   Department of Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Doreen Lagemann
1   Department of Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Christopher Gestrich
1   Department of Cardiac Surgery, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Franz Masseli
2   Department of Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Rheinland-Pfalz, Germany
,
Mehmet Oezkur
2   Department of Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Rheinland-Pfalz, Germany
,
Markus Velten
3   Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Hendrik Treede
2   Department of Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Rheinland-Pfalz, Germany
,
Georg Daniel Duerr 
2   Department of Cardiovascular Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Rheinland-Pfalz, Germany
› Author Affiliations
› Further Information
   Permissions and Reprints All articles of this category

Abstract

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.

Keywords

coronary artery bypass graft surgery - percutaneous coronary intervention - quality of life

Authors' Contribution

Conceptualization: G.D.D., M.H., C.G. Methodology: G.D.D., M.H., N.K., F.M., C.G. Software: M.H., N.K., D.L., C.G., F.M. Validation: N.K., M.H., F.M., C.G. Formal analysis: G.D.D., M.H., N.K. Investigation: G.D.D., M.H., N.K. Resources: G.D.D., N.K., D.L. Data curation: M.H., N.K., D.L., G.D.D. Writing – original draft preparation: M.H., N.K., G.D.D. Writing – review and editing: G.D.D., C.G., M.O., M.V., H.T. visualization: G.D.D., M.H., F.M., M.O., M.V., H.T. Supervision: G.D.D., M.H.. Project administration: G.D.D., M.H.


* These authors contributed equally to this article.


Supplementary Material



Publication History

Received: 14 February 2023

Accepted: 15 May 2023

Accepted Manuscript online:
07 June 2023

Article published online:
31 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe 2015: epidemiological update. Eur Heart J 2015; 36 (40) 2673-2674
    CrossrefPubMedGoogle Scholar
  • 2 Heidenreich PA, Trogdon JG, Khavjou OA. et al; American Heart Association Advocacy Coordinating Committee, Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123 (08) 933-944
    CrossrefPubMedGoogle Scholar
  • 3 Melina G, Angeloni E, Refice S. et al. Clinical SYNTAX score predicts outcomes of patients undergoing coronary artery bypass grafting. Am Heart J 2017; 188: 118-126
    CrossrefPubMedGoogle Scholar
  • 4 Neumann FJ, Sousa-Uva M, Ahlsson A. et al; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40 (02) 87-165
    CrossrefPubMedGoogle Scholar
  • 5 Windecker S, Kolh P, Alfonso F. et al; Authors/Task Force members. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS): developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35 (37) 2541-2619
    CrossrefPubMedGoogle Scholar
  • 6 Serruys PW, Morice MC, Kappetein AP. et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360 (10) 961-972
    CrossrefPubMedGoogle Scholar
  • 7 Kundu A, Sardar P, O'Day K, Chatterjee S, Owan T, Dawn Abbott J. SYNTAX score and outcomes of coronary revascularization in diabetic patients. Curr Cardiol Rep 2018; 20 (05) 28
    CrossrefPubMedGoogle Scholar
  • 8 Bundhun PK, Yanamala CM, Huang F. Percutaneous coronary intervention, coronary artery bypass surgery and the SYNTAX score: a systematic review and meta-analysis. Sci Rep 2017; 7: 43801
    CrossrefPubMedGoogle Scholar
  • 9 Serruys PW, Onuma Y, Garg S. et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention 2009; 5 (01) 50-56
    CrossrefPubMedGoogle Scholar
  • 10 Sianos G, Morel MA, Kappetein AP. et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1 (02) 219-227
    PubMedGoogle Scholar
  • 11 Farooq V, van Klaveren D, Steyerberg EW. et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet 2013; 381 (9867) 639-650
    CrossrefPubMedGoogle Scholar
  • 12 Ohlmeier C, Czwikla J, Enders D. et al. Percutaneous coronary interventions : Use between 2004 and 2012 in Germany [in German]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59 (06) 783-788
    PubMedGoogle Scholar
  • 13 Landes U, Bental T, Levi A. et al. Temporal trends in percutaneous coronary interventions thru the drug eluting stent era: Insights from 18,641 procedures performed over 12-year period. Catheter Cardiovasc Interv 2018; 92 (04) E262-E270
    CrossrefPubMedGoogle Scholar
  • 14 Thielmann M, Leyh R, Massoudy P. et al. Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery. Circulation 2006; 114 (1, Suppl): I441-I447
    CrossrefPubMedGoogle Scholar
  • 15 Hassan A, Buth KJ, Baskett RJ. et al. The association between prior percutaneous coronary intervention and short-term outcomes after coronary artery bypass grafting. Am Heart J 2005; 150 (05) 1026-1031
    CrossrefPubMedGoogle Scholar
  • 16 Farkouh ME, Domanski M, Sleeper LA. et al; FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367 (25) 2375-2384
    CrossrefPubMedGoogle Scholar
  • 17 Head SJ, Kaul S, Mack MJ. et al. The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. Eur Heart J 2013; 34 (32) 2510-2518
    CrossrefPubMedGoogle Scholar
  • 18 Frutkin AD, Lindsey JB, Mehta SK. et al; NCDR (National Cardiovascular Data Registry). Drug-eluting stents and the use of percutaneous coronary intervention among patients with class I indications for coronary artery bypass surgery undergoing index revascularization: analysis from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 2009; 2 (07) 614-621
    CrossrefPubMedGoogle Scholar
  • 19 Lisboa LA, Mejia OA, Dallan LA. et al. Previous percutaneous coronary intervention as risk factor for coronary artery bypass grafting. Arq Bras Cardiol 2012; 99 (01) 586-595
    PubMedGoogle Scholar
  • 20 O'Brien SM, Feng L, He X. et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: part 2-statistical methods and results. Ann Thorac Surg 2018; 105 (05) 1419-1428
    PubMedGoogle Scholar
  • 21 Filardo G, Maggioni AP, Mura G. et al. The consequences of under-use of coronary revascularization; results of a cohort study in Northern Italy. Eur Heart J 2001; 22 (08) 654-662
    CrossrefPubMedGoogle Scholar
  • 22 Miguel GSV, Sousa AG, Silva GS, Colósimo FC, Stolf NAG. Does prior percutaneous coronary intervention influence the outcomes of coronary artery bypass surgery?. Rev Bras Cir Cardiovasc 2020; 35 (01) 1-8
    PubMedGoogle Scholar
  • 23 Hamiko M, Slottosch I, Scherner M. et al. Timely extracorporeal membrane oxygenation assist reduces mortality after bypass surgery in patients with acute myocardial infarction. J Card Surg 2019; 34 (11) 1243-1255
    CrossrefPubMedGoogle Scholar
  • 24 Dangas GD, Farkouh ME, Sleeper LA. et al; FREEDOM Investigators. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM trial. J Am Coll Cardiol 2014; 64 (12) 1189-1197
    CrossrefPubMedGoogle Scholar
  • 25 Spadaccio C, Benedetto U. Coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: quo vadis? -a review of the evidences on coronary artery disease. Ann Cardiothorac Surg 2018; 7 (04) 506-515
    CrossrefPubMedGoogle Scholar
  • 26 Deb S, Wijeysundera HC, Ko DT, Tsubota H, Hill S, Fremes SE. Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. JAMA 2013; 310 (19) 2086-2095
    CrossrefPubMedGoogle Scholar
  • 27 Hannan EL, Samadashvili Z, Walford G. et al. Predictors and outcomes of ad hoc versus non-ad hoc percutaneous coronary interventions. JACC Cardiovasc Interv 2009; 2 (04) 350-356
    CrossrefPubMedGoogle Scholar
  • 28 Massoudy P, Thielmann M, Lehmann N. et al. Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis. J Thorac Cardiovasc Surg 2009; 137 (04) 840-845
    CrossrefPubMedGoogle Scholar
  • 29 Mehta GS, LaPar DJ, Bhamidipati CM. et al. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting. Surgery 2012; 152 (01) 5-11
    CrossrefPubMedGoogle Scholar
  • 30 Boening A, Niemann B, Wiedemann A. et al. Coronary stenting before coronary artery bypass graft surgery in diabetic patients does not increase the perioperative risk of surgery. J Thorac Cardiovasc Surg 2011; 142 (02) e53-e57
    CrossrefPubMedGoogle Scholar
  • 31 Mannacio V, Di Tommaso L, De Amicis V. et al. Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery. Ann Thorac Surg 2012; 93 (06) 1956-1962
    CrossrefPubMedGoogle Scholar
  • 32 Gaszewska-Zurek E, Zurek P, Kaźmierski M. et al. Coronary artery bypass grafting in patients with relatively recent previous stent implantation: three years follow-up results. Cardiol J 2009; 16 (04) 312-316
    PubMedGoogle Scholar
  • 33 Rai P, Taylor R, Bittar MN. Long-term survival in patients who had CABG with or without prior coronary artery stenting. Open Heart 2020; 7 (02) e001160
    CrossrefPubMedGoogle Scholar
  • 34 Biancari F, Dalén M, Ruggieri VG. et al. Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting. J Am Heart Assoc 2018; 7 (20) e010089
    CrossrefPubMedGoogle Scholar
  • 35 Bonaros N, Vill D, Wiedemann D. et al. Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in patients with previous percutaneous intervention. Eur J Cardiothorac Surg 2011; 39 (06) e164-e169
    CrossrefPubMedGoogle Scholar
  • 36 EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 1990; 16 (03) 199-208
    CrossrefPubMedGoogle Scholar
  • 37 Kamiya H, Ushijima T, Mukai K, Ikeda C, Ueyama K, Watanabe G. Late patency of the left internal thoracic artery graft in patients with and without previous successful percutaneous transluminal coronary angioplasty. Interact Cardiovasc Thorac Surg 2004; 3 (01) 110-113
    CrossrefPubMedGoogle Scholar
  • 38 Mohr FW, Morice MC, Kappetein AP. et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381 (9867) 629-638
    CrossrefPubMedGoogle Scholar
  • 39 Stolker JM, Cohen DJ, Kennedy KF. et al; Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) Investigators. Repeat revascularization after contemporary percutaneous coronary intervention: an evaluation of staged, target lesion, and other unplanned revascularization procedures during the first year. Circ Cardiovasc Interv 2012; 5 (06) 772-782
    CrossrefPubMedGoogle Scholar
  • 40 Cohen DJ, Van Hout B, Serruys PW. et al; Synergy between PCI with Taxus and Cardiac Surgery Investigators. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. N Engl J Med 2011; 364 (11) 1016-1026
    CrossrefPubMedGoogle Scholar