الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Coronary artery disease (CAD) represents one of the leading causes of death worldwide. Data obtained from multiple randomized controlled trials comparing CABG to PCI have shown that PCI is inferior to CABG in terms of the need for repeat revascularization and recurrence of ischemic symptoms especially in diabetic patients and patients with complex multivessel disease even in the era of Drug Eluting Stents. The need for repeat revascularization in patients previously treated with PCI has resulted in an increasing percentage of CABG surgery performed in patients with prior stent insertion. There are growing number of evidence that a previous PCI has a negative impact on subsequent CABG. Our study evaluated the short-term impact of prior PCI on CABG.
We performed a prospective cohort study including 60 patients admitted at The New Alexandria University Hospital from January 2018 to January 2020 for elective isolated CABG. Two groups were designed, group A includes 30 patients without a previous history of PCI and group B which includes 30 patients with prior PCI. Data of interest include preoperative demographic data, cardiovascular risk factors, comorbidities, PCI details. Intraoperative data include bypass and cross-clamp time, number of grafts performed, and morphology of coronaries. Postoperative data were incidence of MACEs, in-hospital mortality, ICU stay, ventilation time, inotropic use, bleeding rate, re-exploration, and use of blood products.
Patients with prior PCI were younger, more likely to be diabetic and have dyslipidemia. They were more likely to have a history of MI. They had a more advanced presentation and an urgent need for revascularization. A higher prevalence of hypertension and lower ejection fraction were both noted in the PCI group but did not reach a statistical significance in the study. Less distal anastomosis was performed in the PCI group due to more ungraftable diseased coronaries. The stented coronaries had a thick wall extending beyond the length of the stent and heavily calcific plaques were encountered frequently which forced the anastomosis to be performed more distally compromising graft patency. Postoperative bleeding was significantly more common in the PCI group, MI, exploration for bleeding, inotropic use, blood products use, ICU stay and ventilation time were higher in the PCI group but they did not reach a statistical significance in the current study. In-hospital mortality was similar among both groups.