Perctuaneous coronary intervention in post coronary artery bypass grafting.the clinical outcome of two different strategies in dealing with single remaining vessel

الملخص EN

Background : Percutaneous Coronary Intervention (PCI) in a patient who had previously undergone coronary artery bypass graft (CABG) surgery and come back with multivessel disease is a challenging procedure.

However, if the patient who had CABG surgery returns back with occluded all conduit vessels except only one artery having critical stenosis this is the great caveat.

Objectives : In the present trial we sought to study the impact of two different percutaneous revascularization strategies in those patients.

Methods : Between October 2000 and October 2006, 35 patients who had last single remaining vessel (SRV) disease and previously had a CABG surgery were the subjects of this study.

Group 1 comprised those on whom PCI was performed for this SRV only (20 patients), while 15 patients represented group 2 where PCI was directed to the SRV besides opening at least one of the other occluded arteries.

Results : The in-hospital outcome was very good in both groups, however, there was less major adverse events (MACE) in group 1 than group 2[0 % vs.

20 %, P = 0.069].

At 30-day there was no any significant difference between both groups as regards the incidence of MACE[10 % vs.

13.2 %, P = 0.58].

After 12 months, mortality was [13.6 % vs.

0 %, P = 0.26].

There was no incidence of myocardial infarction among either groups and target vessel revascularization was[9.1 % vs.

33.3 %, P = 0.098].

At long-term follow-up the second revascularization strategy had a greater impact on the improvement of the left ventricular systolic function[EF].

Conclusion : The feasibility of PCI in these high risk groups of patients with last single remaining vessel disease, with either strategy, is possible and offers a good remedy when medical therapy fails in patients who had a previous CABG.