Journals
PCI vs No PCI before CABG

Impact of PCI vs No PCI Before CABG on Short- and Long-Term Survival

March 16, 2017

Coronary artery bypass surgery (CABG) is a typical treatment of choice for coronary heart disease (CHD) patients who have previously received percutaneous coronary intervention (PCI). Prior PCI is often used to stabilize symptoms and improve outcomes following treatment. Multiple staged PCIs may be used as an alternative revascularization strategy for CABG. The impact of prior PCI on CABG outcomes, however, has remained a subject of debate.

PCI can be an effective myocardial revascularization method in some patients, yet some studies conducted before the prevalent use of drug-eluting stents (DES) have previously reported adverse events following PCI prior to CABG.1,2

A retrospective study from The Annals of Thoracic Surgery evaluated the survival impact of PCI before CABG for CHD patients (N=4634).3 According to the data, 30-day mortality was 0.9% for patients with prior PCI vs 1.1% for patients with no prior PCI (Figure 1).

Figure 1. Unmatched (A) vs Matched (B) Patients: Overall Survivala
aData from Luthra S, Leiva Juarez MM, Senanayake E, et al3

Patients with a previous myocardial infarction were more likely to undergo PCI followed by CABG (69.81% vs 27.95%).

While some studies report more short- and long-term adverse events (AEs) of prior PCI on CABG, conflicting data from other registry-based studies and large datasets show little to no AEs in relation to prior PCI.

In this study, patients receiving PCI prior to CABG, on average, were:

  • Younger age
  • More symptomatic
  • Lesser coronary disease burden
  • Higher need for subsequent revascularization
  • Greater grafting time despite requiring fewer grafts

Patients with a left ventricular ejection fraction of <30% who received prior PCI experienced a greater survival benefit at and beyond 5 years. In conclusion, this study suggested prior PCI does not unfavorably affect survival for patients receiving both PCI and CABG.

References:

  1. Barakate MS, Hemli JM, Hughes CF, Bannon PG, Horton MD. 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(2):179-186.
  2. Niclauss L, Colombier S, Prêtre R. Percutaneous coronary interventions prior to coronary artery bypass surgery. J Card Surg. 2015;30(4):313-318.
  3. Luthra S, Leiva Juarez MM, Senanayake E, et al. Percutaneous Intervention Before Coronary Artery Bypass Surgery Does Not Unfavorably Impact Survival: A Single-Center Propensity-Matched Analysis. Ann Thorac Surg. 2016;102(6):1911–1918.

# NPS-008-17