Follow-Up and Outcome after Coronary Bypass Surgery Preceded by Coronary Stent Implantation.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-09-01 Epub Date: 2023-06-07 DOI:10.1055/a-2107-0481
Marwan Hamiko, Nicole Konrad, Doreen Lagemann, Christopher Gestrich, Franz Masseli, Mehmet Oezkur, Markus Velten, Hendrik Treede, Georg Daniel Duerr
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引用次数: 0

Abstract

Background:  Guidelines on myocardial revascularization define recommendations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Only little information exists on long-term follow-up and quality of life (QoL) after CABG preceded by PCI. The aim of our study was to evaluate the impact of prior PCI on outcome and QoL in patients with stable coronary artery disease who underwent CABG.

Methods:  In our retrospective study, CABG patients were divided in: CABG preceded by PCI: PCI-first (PCF), and CABG-only (CO) groups. The PCF group was further divided in guideline-conform (GCO) and guideline nonconform (GNC) subgroups, according to the SYNTAX score (2014 European Society of Cardiology [ESC]/European Association for Cardio-Thoracic Surgery [EACTS] guidelines). Thirty days mortality, major adverse cardiac events, and QoL using the European Quality-of-Life-5 Dimensions were evaluated.

Results:  A total of 997 patients were analyzed, of which 784 underwent CABG without (CO), and 213 individuals with prior PCI (PCF). The latter group consisted of 67 patients being treated in accordance (GCO), and 24 in discordance (GNC) to the 2014 ESC/EACTS guidelines. Reinfarction (PCF: 3.8% vs. CO: 1.0%; p = 0.024), re-angiography (PCF: 17.6% vs. CO: 9.0%; p = 0.004), and re-PCI (PCF: 10.4% vs. CO: 3.0%; p < 0.001) were observed more frequently in PCF patients. Also, patients reported better health status in the CO compared to PCF group (CO: 72.48 ± 19.31 vs. PCF: 68.20 ± 17.86; p = 0.01). Patients from the guideline nonconform subgroup reported poorer health status compared to the guideline-conform group (GNC: 64.23 ± 14.56 vs. GCO: 73.42 ± 17.66; p = 0.041) and were more likely to require re-PCI (GNC: 18.8% vs. GCO: 2.4%; p = 0.03). Also, GNC patients were more likely to have left main stenosis (GCO: 19.7% vs. GNC: 37.5%; p < 0.001) and showed higher preinterventional SYNTAX score (GCO: 18.63 ± 9.81 vs. GNC: 26.67 ± 5.07; p < 0.001).

Conclusion:  PCI preceding CABG is associated with poorer outcomes such as reinfarction, re-angiography, and re-PCI, but also worse health status and higher rehospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart Team decision.

冠状动脉支架植入术前冠状动脉搭桥手术后的随访和结果。
背景:心肌血运重建指南规定了经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植手术(CABG)的建议。关于先行 PCI 后行 CABG 的长期随访和生活质量(QoL)的信息很少。我们的研究旨在评估先行 PCI 对接受 CABG 的稳定型冠心病患者的预后和 QoL 的影响:在我们的回顾性研究中,CABG 患者被分为以下几类:方法:在我们的回顾性研究中,CABG 患者被分为:CABG 前行 PCI:PCI-first(PCF)组和仅 CABG(CO)组。根据SYNTAX评分(2014年欧洲心脏病学会[ESC]/欧洲心胸外科协会[EACTS]指南),PCF组又分为符合指南组(GCO)和不符合指南组(GNC)。对30天死亡率、主要心脏不良事件和使用欧洲生活质量-5维度的QoL进行了评估:共对 997 名患者进行了分析,其中 784 人未接受过 CABG(CO),213 人接受过 PCI(PCF)。后者包括67名按照2014年ESC/EACTS指南治疗的患者(GCO)和24名不按照2014年ESC/EACTS指南治疗的患者(GNC)。再梗死(PCF:3.8% vs. CO:1.0%;P = 0.024)、再血管造影(PCF:17.6% vs. CO:9.0%;P = 0.004)和再PCI(PCF:10.4% vs. CO:3.0%;P = 0.01)。与符合指南组相比,不符合指南亚组患者的健康状况更差(GNC:64.23 ± 14.56 vs. GCO:73.42 ± 17.66;p = 0.041),更有可能需要再次PCI(GNC:18.8% vs. GCO:2.4%;p = 0.03)。此外,GNC 患者更有可能出现左主干狭窄(GCO:19.7% vs. GNC:37.5%;p p 结论:在 CABG 之前进行 PCI 与再梗死、再血管造影和再 PCI 等较差的预后相关,同时也与较差的健康状况和较高的再住院率相关。尽管如此,如果PCI符合指南要求,结果会更好。这些数据应该会影响心脏小组的决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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