Abstract
Objective: to study the results of coronary artery bypass surgery in patients with coronary artery disease with
recurrent angina after previously suffering stenting (CAS) and the definition of further tactics of treatment.
Material and methods. During the period from 2009 to 2015, operation of the isolated coronary artery bypass
grafting (CABG) performed in 1099 patients. Of these, 94 (8.6%) patients at various intervals before surgery
suffered endovascular intervention with stenting of the coronary arteries (PCI) – I group: 63 single SKA –
IA subgroup; 31 – multiple (≥ 2) PCI (IB subgroup). The control group – 201 patients who did not have
prior to the operation of any endovascular interventions on the coronary vessels. Examined effects of stenting
on immediate and late results of subsequent CABG surgery. Analysis of long-term results was performed
using the Kaplan–Meier method.
Results. Despite the lack of statistical significance, perioperative mortality tended to increase in patients not
only group IB relative to the control group of patients, but also to the subgroup IA (6.4, 2.9 and 4.7%, respectively).
Perioperative myocardial infarction (MI), congestive heart failure and the need for intra-aortic balloon
counterpulsation (IABP) were also significantly higher in patients with IB group. The long-term survival
(for the period by an average 78.3±23.4 months) in patients with IB group was reduced compared with
patients IA and control groups (80.0±0.07% against 91.1±0.3% and 92.2±0.4%, respectively, p<0.05).
Postoperative clinical course of ischemic heart disease in this group of patients in the remote period was
characterized by an increased rate of myocardial infarction: 9.8% vs. 4.7%; congestive heart failure (9.3% vs.
13.7%). Freedom from angina or other coronary events have also been significantly reduced (56.2% vs. 72.4,
and 87.1%, respectively, p<0.05).
Conclusion. Repeatedly and / or multiple PCI is associated with an increased risk of perioperative complications
in the subsequent CABG with the worst long-term prognosis, which should be considered when
choosing a surgical treatment of patients in this group.
References
- Bockeria L.A., Berishvili I.I., Solnyshkov I.V., Khvi-chiya L.E., Kasaeva Z.T., Gusev P.V. Repeated opera-tions in patients with ischemic heart disease. Currentstate of the problem (meta-analysis). Bulletin ofBakoulev Center for Cardiovascular Diseases.2009;10 (3): 5–27 (in Russ.)
- Mehta G., LaPar D., Bhamidipati C., Kern J., Kron I.,
Upchurch G., Ailawadi G. Previous percutaneous
coronary intervention increases morbidity after coronary
artery bypass grafting. Surgery. 2012; 152 (1): 5–11.
DOI: 10.1016/j.surg.2012.02.013
- Niclauss L., Colombier S., Pre^tre R. Percutaneous
coronary interventions prior to coronary artery bypass
surgery. J. Cardiac Surg. 2015; 30 (4): 313–8. DOI:
10.1111/jocs.12514
- Niclauss L., Colombier S., Pre^tre R. Percutaneouscoronary interventions prior to coronary artery bypasssurgery. J. Cardiac Surg.2015; 30 (4): 313–8. DOI:10.1111/jocs.12514
- Velicki L. Does prior coronary stenting compromise
future coronary surgery? Interv. Cardiol. 2013; 5 (1):
93–100. DOI: 10.2217/ica.12.82
- Mohr F.W., Morice M.C., Kappetein A.P., Feldman
T.E., Sta° hle E., Colombo A. 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:
629–38. DOI: 10.1016/S0140-6736(13)60141-5
- Taggart D. Stents or surgery in coronary artery disease
in 2013. Ann. Cardiothorac. Surg. 2013; 2 (4): 431–4.
DOI: 10.3978/j.issn.2225-319X.2013.07.20
- Stolker J.M., Cohen D.J., Kennedy K.F., Pencina
M.J., Lindsey J.B., Mauri L. et al. 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: 772-882.
DOI: 10.1161/CIRCINTERVENTIONS.111.967802
- Sakaguchi G., Shimamoto T., Komiya T. Impact of
repeated percutaneous coronary intervention on long-
term survival after subsequent coronary artery bypass
surgery. J. Cardiothorac. Surg. 2011; 6: 107. DOI:
10.1186/1749-8090-6-107
- Bonaros N., Hennerbichler D., Friedrich G., Kocher A.,
Pachinger O., Laufer G., Bonatti J. Increased mortality
and perioperative complications in patients with previous
elective percutaneous coronary interventions
undergoing coronary artery bypass surgery. J. Thorac.
Cardiovasc. Surg. 2009; 137 (4): 846–52. DOI: 10.1016/
j.jtcvs.2008.09.041
- Thielmann M., Leyh R., Massoudy P., Neuhauser M.,
Aleksic I., Kamler M. et al. Prognostic significance of
multiple previous percutaneous coronary interventions
in patients undergoing elective coronary artery bypass
surgery. Circulation. 2006; 114 (1 suppl.): I441–7.
- Mannacio V., Di Tommaso L., De Amicis V., Luccheti
V. et al. Previous percutaneous coronary interventions
increase mortality and morbidity after coronary surgery.
Ann. Thorac. Surg. 2012; 93 (6): 1956–62. DOI:
10.1016/j.athoracsur.2012.02.067
- Hassan A., Buth K.J., Baskett R.J., Ali I.S., Maitland
A. et al. The association between prior percutaneous
coronary intervention and short-term outcomes
after coronary artery bypass grafting. Am. Heart J. 2005;
150 (5): 1026–31. DOI: 10.1016/j.ahj.2005.03.035
- Lisboa L.A., Mejia O.A., Dallan L.A. et al. Previous
percutaneous coronary intervention as risk factor for
coronary artery bypass grafting. Arq. Bras. Cardiol.
2012; 99 (1): 586–95.
- Bockeria L.A., Kovalenko O.A., Iraskhanov A.K.,Zeynalov E.K., Vishchipanov A.S. Aortocoronarybypass in patients with recurrent angina after previouscoronary artery stenting. Annaly Khirurgii (Annals ofSurgery). 2012; 1: 61–5 (in Russ.)
- Yap C.H., Yan B.P., Akowuah E. et al. Does prior percutaneous
coronary intervention adversely affect early
and mid-term survival after coronary artery surgery?
JACC Cardiovasc. Interv. 2009; 2 (8): 758–64.
- Sanchez E., Cid-Cumplido M., Moreno E., Tarnini I.,
Khan I., Pineda T., Gonzales J.R. Previous percutaneous
coronary intervention does not increase in-hospital
mortality after surgical revascularization: Analysis
of 63420 cases. Arg. J. Cardiol. 2013; 81: 208–14.
- Luthra S., Leiva Juárez M.M., Senanayake E., Luckraz
H., Billing J.S., Cotton J., Norell M.S. Percutaneous
intervention before coronary artery bypass
surgery does not unfavorably impact survival: a singlecenter
propensity-matched analysis. Ann. Thorac. Surg.
2016; 102 (6): 1911–8. DOI: 10.1016/j.athoracsur.
2016.07.046
- Jones H., Hannan L., Hammermeister E., Delong R.,
O'Connor T., Luepker V., Parsonnet V., Pryor B.
Identification of preoperative variables needed for risk
adjustment of short-term mortality after coronary artery
bypass graft surgery. J. Am. Coll. Cardiol. 1996; 28 (6):
1478–87. DOI: 10.1016/S0735-1097(96)00359-2
- Grover F.L., Johnson R.R., Shroyer W., Marshall G.,
Hammermeister K. The veterans affairs continuous
improvement in cardiac surgery study. Ann. Thorac.
Surg. 1994; 58 (6): 1845–51.
- Kovalenko O.A., Vishchipanov S.A., Bendeliani N.G.,Krymov K.V., Musin D.E., Cheishvili Z.M., Zeyna-lov E.K., Orlov I.N. Long-term results of surgical treat-ment of ischemic heart disease in patients with previouselective percutaneous coronary artery intervention.Russian Journal of Thoracic and Cardiovascular Surgery.2016; 58 (6): 159–65 (in Russ.).
- Biancari F., Mariscalco G., Rubino A.S., G. Vinco,
Onorati F., Faggian G. et al. The effect of prior percutaneous
coronary intervention on the immediate and
late outcome after coronary artery bypass grafting: systematic
review and meta-analysis. Heart, Lung Vessels.
2014; 6 (4): 244–52.
- Ueki C., Sakaguchi G., Akimoto T., Shintani T., Ohashi
Y., Sato H. Influence of previous percutaneous
coronary intervention on clinical outcome of coronary
artery bypass grafting: a meta-analysis of comparative
studies. Interact. Cardiovasc. Thorac. Surg. 2015; 20;
531–7. DOI:10.1093/icvts/ivu449
- Tran H., Barnett S.D., Hunt S.L., Chon A., Ad N. The
effect of previous coronary artery stenting on short- and
intermediate-term outcome after surgical revascularization
in patients with diabetes mellitus. J. Thorac.
Cardiovasc. Surg. 2009; 138 (2): 316–23.
- Nauffal V., Schwann T.A., Yammine M.B., Abdul-
Karim M. El-Hage-Sleiman, El Zein M.H. et al.
Impact of prior intracoronary stenting on late outcomes
of coronary artery bypass surgery in diabetics with triplevessel
disease. J. Thorac. Cardiovasc. Surg. 2015; 149
(Iss. 5): 1302–9. DOI: 10.1016/j.jtcvs.2015.01.051
- Eifert S., Mair H., Boulesteix A.L., Kilian E., Adamczak
M., Reichart B., Lamm P. Mid-term outcomes of
patients with PCI prior to CABG in comparison to patients
with primary CABG. Vasc. Health Risk Management.
2010; 6: 495–501. DOI: 10.2147/ VHRM.S8560
- Kamiya H., Ushijima T., Mukai K. et al. 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: 110–3. DOI: 10.1016/S1569-9293(03)00229-9
- Songur M., O¨ zyalc, in S., O¨ zen A. et al. Does really previous
C= stenting affect graft patency following CABG?
A 5-year follow-up: the effect of PCI on graft survival.
Heart Vessels. 2016; 31: 457–64. DOI: 10.1007/s00380-
015-0633-9
- Gaudino M., Celini C., Pragliola C., Trani C., Burzotta
F., Schiavoni G., et al. Arterial versus venous bypass
grafts in patients with in-stent restenosis. Circulation.
2005; 112 (Suppl. I): I-265–I-269. DOI: 10.1161/
CIRCULATIONAHA.104.512905
- Farah R., Shurtz-Swirski R., Bolotin Y. et al. Oxidative
stress and inflammation due to peripheral polymorphonuclear
leukocytes after coronary angiography vs
percutaneous coronary intervention. Minerva
Cardioangiol. 2008; 56: 189–95.
- Kovalenko O.A., Iraskhanov A.K. Tactics of surgicaltreatment of patients with ischemic patients andpatients with angina recurrence after previously per-formed coronary artery stenting. Annaly Khirurgii(Annals of Surgery).2011; 5: 56–9 (in Russ).
About the authors
Kovalenko Oleg Aleksandrowich, Dr Med. Sc., Leading Researcher; orcid.org/0000-0003-4485-3964
