Downloads
Abstract
Background: Percutaneous coronary intervention (PCI) is the preferred treatment modality for single and double vessel coronary artery disease and in the setting of acute coronary syndrome. The rising volume of PCI is directly proportional to the representation of patients hospitalized for coronary artery bypass graft (CABG) surgery who have a history of previous PCI procedures. This study aims to 1) identify the risk factors in patients requiring revascularization with prior PCI and 2) evaluate the surgical outcomes.
Materials and method: This is a retrospective case series of patients with prior PCI undergoing elective CABG surgery at Hue Central Hospital.
Results: From January 2012 and January 2017, 16 patients operated. The mean age was 64.6
± 8.2. Mean Body Mass Index was 24.7 ± 1.8. The PCI and CABG gap was 2 years. Coronary risk factors including hypertension (87.5%), diabetes mellitus (81.3%), dyslipidemia (68.8%) and smoke (62.5%). All patients presented stable angina with 62.5% CCS class IV. Mean cardiopulmonary bypass time was 125.3 ± 19.5 minutes, 37.5% off - pump coronary surgery. Multi - bypass bypass grafting was performed in 87.5%. Surgical complications were recognized, including 43.8% bleeding, 12.5% atrial fibrillation, and 6.25% stroke. A case required an intra - aortic balloon pump during the postoperative period. Mean hospital stay was 27.4 ± 8.5 days. There was no mortality during hospitalization and 6 - month follow - up.
Conclusion: Risk factors for surgical outcome in patients requiring coronary revascularization with prior PCI include diabetes mellitus, smoking, hypertension, time of CABG surgery after PCI, previously intervened vessels, coronary revascularization strategies, and left ventricular ejection fraction. CABG is an appropriate modality for reperfusion in these patients with positive early outcomes.
Keywords: Percutaneous coronary intervention, coronary artery bypass grafting, revascularization
References
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019. 40: 87-165.
Taggart DP. Coronary artery bypass grafting is still the best treatment for multivessel and left main disease, but patients need to know. Ann Thorac Surg. 2006. 82: 1966-75.
Biancari F, Dalen M, Ruggieri VG, Demal T, Gatti G, Onorati F, et al. Prognostic Impact of Multiple Prior Percutaneous Coronary Interventions in Patients Undergoing Coronary Artery Bypass Grafting. J Am Heart Assoc. 2018. 7: e010089.
O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V, et al. The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results. Ann Thorac Surg. 2018. 105: 1419-28.
Hillis L.D., Smith P.K., Anderson J.L., Bittl
J.A., Bridges C.R. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011. 124: 652-735.
Borde D, Gandhe U, Hargave N, Pandey K, Khullar V. The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery. Ann Card Anaesth. 2013. 16: 163-6.
Christensen MC, Dziewior F, Kempel A, von Heymann C. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2012. 26: 46-51.
Bugajski P, Greberski K, Kuzemczak M, Kalawski R, Jarzabek R, Siminiak T. Impact of
previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting. Kardiol Pol. 2018. 76: 953-9.
Parasca CA, Head SJ, Milojevic M, Mack MJ, Serruys PW, Morice MC, et al. Incidence, Characteristics, Predictors, and Outcomes of Repeat Revascularization After Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: The SYNTAX Trial at 5 Years. JACC Cardiovasc Interv. 2016. 9: 2493-507.
Massoudy P, Thielmann M, Lehmann N, Marr A, Kleikamp G, Maleszka A, 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: 840-5.
Kahlon RS, Armstrong EJ. Coronary Artery Bypass Grafting Among Patients With Prior Percutaneous Coronary Interventions. J Am Heart Assoc. 2018. 7: e010609.
Ueki C, Sakaguchi G. Repeated Coronary Revascularization in the Era of the Heart Team. Ann Thorac Surg. 2017. 104: 2126.
Fukui T, Tanaka S, Takanashi S. Previous coronary stents do not increase early and long- term adverse outcomes in patients undergoing off-pump coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2014. 148: 1843-9.
WHO. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet. 2004. 363: 157-63.
Stevens LM, Khairy P, Agnihotri AK. Coronary artery bypass grafting after recent or remote percutaneous coronary intervention in the Commonwealth of Massachusetts. Circ Cardiovasc Interv. 2010. 3: 460-7.
Võ Tuấn Anh, Phạm Thọ Tuấn Anh. Đánh giá nguy cơ phẫu thuật ở bệnh nhân phẫu thuật van tim và bắc cầu mạch vành: so sánh hiệu quả của
thang điểm EuroSCORE II và thang điểm STS. Tạp chí Y học TP.HCM. 2013. tập 17: 220-6.
Bùi Đức An Vinh, Nguyễn Hoàng Nam, Nguyễn Bá Phong, Sawadogo A, Azarnoush A. Evaluation of the Result of Sutureless Aortic Valve Replacement. Journal of Medicine and Pharmacy. 2019. 9: 44-50.
Karaca I, Aydin K, Yavuzkir M, Ilkay E, Akbulut M, Isik A, et al. Predictive value of C-reactive protein in patients with unstable angina pectoris undergoing coronary artery stent implantation. J Int Med Res. 2005. 33: 389-96.
Muhlestein JB. Endothelial dysfunction associated with drug-eluting stents what, where, when, and how? J Am Coll Cardiol. 2008. 51: 2139-40.
Yap CH, Yan BP, Akowuah E, Dinh DT, Smith JA, Shardey GC, et al. Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery? JACC Cardiovasc Interv. 2009. 2: 758-64.
Mazhar J, Figtree G, Vernon ST, Galougahi KK, Carlo J, Nissen SE, et al. Progression of coronary atherosclerosis in patients without standard modifiable risk factors. Am J Prev Cardiol. 2020. 4: 100116.
Farah I, Ahmed AM, Odeh R, Alameen E, Al-Khateeb M, Fadel E, et al. Predictors of Coronary Artery Disease Progression among High-risk Patients with Recurrent Symptoms. Heart Views. 2018. 19: 45-8.
Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation. 2001. 103: 1967-71.
Alfonso F, Hernández C, Pérez-Vizcayno MaJ, Hernández R, Fernández-Ortı́z A, Escaned J, et al. Fate of stent-related side branches after
coronary intervention in patients with in- stent restenosis. J Am Coll Cardiol. 2000. 36: 1549-56.
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: I441-7.
Eifert S, Mair H, Boulesteix AL, Kilian E, Adamczak M, Reichart B, et al. Mid-term outcomes of patients with PCI prior to CABG in comparison to patients with primary CABG. Vasc Health Risk Manag. 2010. 6: 495-501.
Nguyễn Hoàng Định, Nguyễn Anh Dũng, Cao Đằng Khang, Ngô Bảo Khoa, Lương Công Hiếu. Phẫu thuật bắc cầu mạch vành no-touch dùng toàn động mạch ngực trong và không tuần hoàn ngoài cơ thể. Tạp chí Y học TP.HCM. 2010. 14: 227.
Yeatman M, Caputo M, Ascione R, Ciulli F, Angelini GD. Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome. Eur J Cardiothorac Surg. 2001. 19: 239-44.
Đoàn Đức Hoằng, Bùi Đức Phú, Đặng Thế Uyên, Bùi Đức An Vinh, Đoàn Chí Hiền. Nghiên cứu so sánh kết quả tuần hoàn ngoài cơ thể giữa hai kiểu hệ thống kín và hở trên bệnh nhân phẫu thuật cầu nối động mạch vành. Tạp chí Phẫu thuật TM&LN Việt Nam. 2016. 13: 50-9.
Barakate M. Coronary artery bypass grafting (CABG) after initially successful percutaneous transluminal coronary angioplasty (PTCA): a review of 17 years experience. Eur J Cardiothorac Surg. 2003. 23: 179-86.
| Published | 19-02-2025 | |
| Fulltext |
|
|
| Language |
|
|
| Issue | No. 71 (2021) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.2021.71.12 | |
| Keywords | Can thiệp mạch vành qua da, bắc cầu chủ vành, tái tưới máu. Percutaneous coronary intervention, coronary artery bypass grafting, revascularization |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2021 Journal of Clinical Medicine Hue Central Hospital