Risk of perioperative coronary stent stenosis or occlusion in patients with previous percutaneous coronary intervention undergoing coronary artery bypass grafting surgery

Media type: E-Article
Title: Risk of perioperative coronary stent stenosis or occlusion in patients with previous percutaneous coronary intervention undergoing coronary artery bypass grafting surgery
Contributor: Grieshaber, Philippe; Oswald, Irina; Albert, Marc; Reents, Wilko; Zacher, Michael; Roth, Peter; Niemann, Bernd; Dörr, Oliver; Krüger, Tobias; Nef, Holger; Sodah, Ayman; Hamm, Christian; Schlensak, Christian; Diegeler, Anno; Sedding, Daniel; Franke, Ulrich; Boening, Andreas
Published: Oxford University Press (OUP), 2020
Published in: European Journal of Cardio-Thoracic Surgery, 57 (2020) 6, Seite 1122-1129
Language: English
DOI: 10.1093/ejcts/ezaa003
ISSN: 1873-734X; 1010-7940
Keywords: Cardiology and Cardiovascular Medicine ; Pulmonary and Respiratory Medicine ; General Medicine ; Surgery
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>There is an ongoing discussion about how to treat coronary stents during bypass surgery: Should patent stents be left alone and the stented vessels be ungrafted, or should every stented coronary artery receive a bypass graft? This study aims to determine the relevance of perioperative stent stenosis or occlusion on postoperative outcomes up to 3 years postoperatively.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Patients undergoing coronary artery bypass grafting surgery (CABG) (±concomitant procedures) with previous percutaneous coronary intervention from 4 centres were prospectively included in this observatory study between April 2015 and June 2017. A coronary angiography was conducted between the fifth and seventh postoperative days. The preoperative and postoperative angiograms were assessed in a core laboratory, assessing the patencies of coronary stents and bypass grafts. The core lab investigators were blinded to the patients’ characteristics and perioperative course.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 107 patients were included in the study. In the postoperative coronary angiography, 265 bypass grafts and 189 coronary stents were examined angiographically. Ninety-seven percent of preoperatively patent stents remained patent. New coronary stent stenoses were observed in 5 patients (4.7%). All 5 patients were asymptomatic and managed conservatively. Bypass stenoses were observed in 12 patients (11%), of whom were managed conservatively, 4 underwent percutaneous coronary intervention and 1 underwent redo-CABG. Two years postoperatively, 97% of patients were alive. Patients with new stent stenosis tended to have a better survival compared with patients with bypass stenosis (100% vs 73%; P = 0.09) up to 3 years postoperatively.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Perioperative coronary stent stenosis occurs rarely. It is safe to leave a patently stented coronary vessel without bypass grafting.</jats:p> </jats:sec>
Access State: Open Access

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