Does prior coronary stenting compromise future coronary surgery?

There has been a tremendous growth in percutaneous coronary interventions (PCIs) with stent implantation, even in cases where coronary artery bypass grafting (CABG) demonstrates superior long-term results – the cases of multivessel coronary disease. With the number of PCIs on the rise, one may expect a growing population of patients with prior PCI to be ultimately referred to CABG as a result of long-term PCI failure, incomplete revascularization or disease progression. It has been suggested that previous PCI might be considered as a risk factor with a negative impact on subsequent CABG procedure. Several large observational studies found that multiple previous coronary stenting has a negative effect on the outcome of a subsequent surgical revascularization – the higher the stent load the worse the outcome. Nevertheless, no definitive conclusion can be made at this point, as this issue is still a matter of significant controversy.