Percutaneous Catheter Interventions Followed by Coronary Artery Bypass Grafting

T he results of the SYNTAX trial (The Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery), 1 the FREEDOM trial (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease), 2 and other studies are providing clarity and even growing consensus among cardiologists and surgeons about the relative roles of percutaneous catheter interventions (PCI) versus coronary artery bypass grafting (CABG) for coronary revascularization.However, there remains a concern, especially among cardiac surgeons, that some patients with prior PCI may be at increased risk of poor outcomes when undergoing subsequent CABG surgery.3,4 In a report in this issue of Circulation: Cardiovascular Interventions from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting), Mariscalco et al 5 acknowledge that the clinical impact of prior PCI in patients who subsequently require CABG remains unsettled.The authors queried the recently established voluntary registry of CABG procedures undertaken at 16 European centers, designated as E-CABG, hoping to answer this persisting concern about possible risks associated with prior PCI at subsequent CABG operations.In addition, they undertook a meta-analysis of publications reporting on outcomes after CABG in patients with prior PCI.