Coronary artery bypass grafting in patients with relatively recent previous stent implantation: three years follow-up results.

Background: An increasing number of patients who undergo coronary artery bypass grafting(CABG) have a history of coronary stent implantation. This study aims to assess perioperative and medium-term follow-up outcomes in patients in whom CABG was preceded by coronary stent implantation within two years before operation.

Methods: One hundred and sixty two patients undergoing CABG after previous stent placement (PCI + CABG group) were compared to 149 who had CABG without PCI in the past (CABG group). Clinical, angiographic and perioperative outcome data were compared. The three year follow-up comprised data on number of deaths and the presence of anginal symptoms.

Results: In both groups the extent of coronary artery disease was comparable, but more patients in the PCI + CABG group had a history of myocardial infarction. Perioperative outcome data did not differ between the groups except for a higher number of vessels considered infarct-related grafted in the CABG group. Patients operated on up to three months after PCI had more extensive coronary heart disease than those operated on later. They also had a significantly shorter operation time. This group also showed a trend towards less postoperative bleeding, less rethoracotomy and less low cardiac output syndrome. In a three year follow-up, 48 (30%) patients in the PCI + CABG group reported presence of angina compared to 28 (19%) in the CABG group (p = 0.04).

Conclusions: Previous PCI does not significantly influence the CABG outcome. In mediumterm follow-up, freedom from anginal symptoms is less likely in patients in whom CABG was preceded by stent implantation.