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சுருக்கம்

Comparison of Clinical Outcomes among Patients Undergoing Coronary Artery Bypass Grafting (CABG) with or without Prior Percutaneous Coronary Intervention (PCI)

Mohamed A Alassal, Hany Elrakhawy, Ahmed H Omar, Magdy Hassenien, Mohamed Aldahmashi, Bedir Ibrahim, Nabil Elsadeck and Mohamed F Ibrahim

Background: There are increasing number of patients who are referred for coronary artery bypass grafting (CABG) after prior percutaneous coronary intervention (PCI). The intent here is to characterize the risk, if any, that is associated with PCI experience prior to CABG.

Methodology and patients: 2358 consecutive patients underwent coronary artery bypass grafting between January 2008 to December 2013 at two tertiary cardiac centers in Middle East (one center in Egypt and one in Saudi Arabia) divided in 2 groups: 1st group-492 patients with Prior PCI to CABG (PPCABG), and the 2nd group-1866 patients underwent CABG without previous PCI (Native Vessel CABG-NVCABG). We chose the 2 groups with similar cardiac morbidities and extra cardiac co-morbidities.

Results: Except for emergency cases, clopidogrel, statin use and the distribution of NYHA classification, the two groups were similar in terms of baseline demographic and pre-operative characteristics. Summarized intra-operative and post-operative data showed that PPCABG group had significantly higher cross clamp time, total bypass time, higher incidence of post-operative complications such as bleeding, renal impairment than NVCABG and also significant higher in-hospital mortality rate in PPCABG group than NVCABG group.

Conclusion: Future re-interventions after PCI are common and both extent of disease and re-stenosis of stents are responsible for re-intervention. PCI prior to CABG increases morbidity post operatively and seem to have an independent factor in increasing mortality. So, in the best interest of the patient, proper consensus among cardiologists and cardiac surgeons must be reached before subjecting to PCI, especially in cases of multivessel coronary artery disease.