Key result
New coronary stent stenosis occurred in 4.7% of CABG patients, who tended to have better 3-year survival compared to patients with bypass stenosis (100% vs 73%; P=0.09).
Why the study?
It remains debated whether patent coronary stents should be left ungrafted during bypass surgery or if every stented artery should receive a bypass graft, prompting evaluation of perioperative stent stenosis or occlusion on postoperative outcomes.
Does leaving patently stented coronary vessels ungrafted during CABG affect perioperative stent stenosis and postoperative survival in patients with previous PCI?
Observational (n=107)
Blinded core lab
Yes
Does leaving patently stented coronary vessels ungrafted during CABG affect perioperative stent stenosis and postoperative survival in patients with previous PCI?
Absolute Event Rate: 100% vs 73%
p-value: p=0.09
Perioperative coronary stent stenosis occurs rarely, suggesting it is safe to leave a patently stented coronary vessel without bypass grafting during CABG.
Rare stent stenosis after CABG without grafting prior stents may support omission; leaves open survival implications in PCI patients.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Perioperative coronary stent stenosis occurs rarely. It is safe to leave a patently stented coronary vessel without bypass grafting.
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Grieshaber et al. (2020) conducted an observational in Previous percutaneous coronary intervention undergoing coronary artery bypass grafting surgery (n=107). New coronary stent stenosis vs. Bypass stenosis was evaluated on Survival up to 3 years postoperatively (p=0.09). New coronary stent stenosis occurred in 4.7% of CABG patients, who tended to have better 3-year survival compared to patients with bypass stenosis (100% vs 73%; P=0.09).
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