Prognostic Impact of Previous Percutaneous Coronary Intervention on the Outcome of Coronary Artery Bypass Grafting in Multivessel Disease Diabetic Patients

Moataz E  Rezk; Ahmed S Hassan; Yasser  Ahmed El-sayed; Yosry  El-Saied Rezk; Ashraf   El-Nahas

Moataz E Rezk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ahmed S Hassan National Heart Institute, Giza, Egypt
Yasser Ahmed El-sayed Military Medical Academy, Cairo, Egypt
Yosry El-Saied Rezk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ashraf El-Nahas Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Percutaneous coronary intervention, Coronary bypass grafting, Diabetes mellitus

Abstract

Background: Previous studies suggest that patients who receive percutaneous coronary intervention (PCI) are at a higher risk of undergoing coronary artery bypass grafting (CABG). This study aimed to investigate the risk of CABG in patients with a history of PCI.

Methods: One hundred diabetic patients who underwent CABG from October 2020 to February 2022 were enrolled and divided into two groups. Group I consisted of 50 patients with no prior PCI, while Group II comprised 50 patients with a history of PCI.

Results: The mean age was 57.4 ± 8.67 years for Group I and 59.72 ± 7.5 years for Group II (p= 0.155). The mean cardiopulmonary bypass time was 108.56 ± 34.53 minutes for Group I and 127.4 ± 35.93 minutes for Group II (p=0.009). The ischemic duration was 75.68 ± 19.94 minutes for Group I and 75.12± 23.02 minutes for Group II. The mean number of grafts was greater in Group I (3.5 (3 – 3.5) vs. 3 (2 – 4), p= 0.011). The mean ventilation time was 9 (5 – 13.75) hours for Group I and 10 (5 – 19) hours for Group II. The mean length of ICU stay was 1 (1–2) day for Group I and 2 (2–3) days for Group II (p<0.001). The length of hospital stay was 8 (7–9) days for Group I and 10 (9–11) days for Group II (p<0.001). There were statistically significant differences between the groups in terms of MACE (higher in the PCI group, p=0.046), improvement in wall motion abnormalities (higher in the non-PCI group, p=0.007), and postoperative normal ejection fraction (higher in the non-PCI group, p=0.032). There was no significant difference in hospital mortality between the two groups (0 vs 3), with a p value =0.07.

Conclusion: A previous PCI could increase post-CABG morbidity and MACEs. However, no significant difference in postoperative mortality rates was found between patients who underwent prior PCI and those who did not.