Early-term results of early coronary artery bypass graft surgery in patients undergoing primary percutaneous coronary intervention due to acute coronary syndrome

Abstract

Objectives: This study aimed to investigate the early results of the patients presented with acute coronary syndrome (ACS) who underwent coronary artery bypass grafting (CABG) after percutaneous coronary intervention (PCI) to the culprit lesion.

Methods: Patients who underwent CABG between January 2011 and January 2014 were enrolled and divided into two groups. Group 1 (102 patients) was consist of the patients who were hospitalized with ACS and underwent CABG after a previous PCI. Group 2 (107 patients) was consisting of the patients who underwent elective CABG operation after elective coronary angiography.

Results: There was no statistically significant difference between the groups in terms of demographic features and preoperative risk factors. Preoperative use of angiotensin-converting enzyme inhibitor and levosimendan were significantly higher in group 1 compared to group 2. (95 (93.1%) vs. 89 (83.1%), p = 0.027). The operative variables were similar between two groups whereas the postoperative blood drainage amounts were significantly higher in group 1 than group 2 (546.3 ± 172 cc vs. 424.2 ± 185 cc, respectively, p < 0.001). The blood product usage was significantly higher in group 1 than in group 2 (3.3 ± 1.8 units vs.1.7 ± 0.9 units, respectively, p < 0.001).

Conclusions: Early CABG operation after ACS is a safely applicable process with acceptable mortality and complication rates. 

Keywords

• Coronary artery disease
• acute coronary syndrome
• coronary artery bypass grafting
• percutaneous coronary intervention

References

1. 1. Roth GA, Huffman MD, Moran AE, Feigin V, Mensah GA, Naghavi M, et al. Global and regional patterns in cardiovasculer mortality from 1990 to 2013. Circulation 2015;132:1667-78.
2. 2. Yalcin M, Ay D, Turk T, Yavuz S, Ozyazicioglu AF. Impact of previous percutaneous coronary intervention on postoperative outcomes of coronary artery bypass grafting. Eur Res J 2016;2:170-6.
3. 3. Goss F, Brachmann J, Hamm CW, Haerer W, Reifart N, Levenson B. High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study. Vasc Health Risk Manag 2017;13:127-37.
4. 4. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2008;51:210-47.
5. 5. Smith SC Jr, Dove JT, Jaccobs AK, Kennedy JW, Kereiakes D, Kern MJ, et al. ACC/AHA Guidelines for Percutaneous Coronary Intervention (Revision of the 1993 PTCA Guidelines). A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty). Endorsed by the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 2001;37:2215-39.
6. 6. Cannon CP, Weintraub WS, Demopoulos LA,Vicari R, Frey MJ, Lakkis N, et al. TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy)-Thrombolysis in Myocardial Infarction 18 Investigators. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001;344:1879-87.
7. 7. Potluri R, Baig M, Mavi JS, Ali N, Aziz A, Uppal H, et al. The role of angioplasty in patients with acute coronary syndrome and previous coronary artery bypass grafting Int J Cardiol 2014;176:760-3.
8. 8. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-53.

9. 9. Hoedemaker NPG, Damman P, Ottervanger JP, Dambrink JHE, Gosseling ATM, Kedhi E, et al. Trends in optimal medical therapy prescription and mortality after admission for acute coronary syndrome: a 9-year experience in a real-world setting. Eur Heart J 2018;4:102-10.
10. 10. Braunwald E, Domanski MJ, Fowler SE, Geller NL, Gersh BJ, Hsia J, et al. Angiotensin-converting enzyme inhibition in stable coronary artery disease. N Engl J Med 2004;351:2058-68.
11. 11. Indio do Brasil CKO, Avezum A Jr, Uint L, Del Monaco MI, Barros VM, Campos SY, et al. Cardiovascular prevention in coronary heart disease patients: guidelines implementation in clinical practice. Rev Bras Cir Cardiovasc 2013;28:238-47.
12. 12. Dagenais GR, Pogue J, Fox K, Simoons ML, Yusuf S. Angiotensin-converting- enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet 2006;368:581-8.
13. 13. Danchin N, Cucherat M, Thuillez C, Durand E, Steg PG. Angiotensin- converting enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction: an overview of long-term randomized controlled trials. Arch Intern Med 2006;166:787-96.
14. 14. Yusuf S, Pogue J. ACE inhibition in stable coronary artery disease. N Engl J Med 2005;352:937-9.
15. 15. Lopez-Sendon J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J 2004;25:1341-62.
16. 16. Chen ZM, Pan HC, Chen YP,Peto R, Collins R, Jiang LX, et al. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1622-32.
17. 17. Eris C, Yavuz S, Toktas F, Turk T, Gucu A, Erdolu B, et al. Preoperative usages of levosimendan in patients undergoing coronary artery bypass grafting. Int J Clin Exp Med 2014;7:219-29.
18. 18. Lim JY, Deo SV, Rababa’h A, Altarabsheh SE, Cho YH, Hang D, et al. Levosimendan reduces mortality in adults with left ventricular dysfunction undergoing cardiac surgery: a systematic review and meta‐analysis. J Card Surg 2015;30:547-54.
19. 19. Yavuz S, Eris C, Ata Y, Turk T. eComment. Preoperative levosimendan administration in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2013;17:714-5.
20. 20. Jin L, Yu H, Dong T, Zhang B, Yan H, Liao H, et al. The prognostic value of ADP-induced platelet aggregation for bleeding complications in low - intermediate risk patients with acute coronary syndrome taking clopidogrel after percutaneous coronary intervention. Heart Lung Circ 2016;26:49-57.
21. 21. Ben-Gal Y, Moses JW, Mehran R, Lansky AJ, Weisz G, Nikolsky E, et al. Surgical versus percutaneous revascularization for multivessel disease in patients with acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. JACC Cardiovasc Interv 2010;3:1059-67.