Percutaneous coronary intervention (PCI) has established itself as an effective alternative to coronary artery bypass grafting (CABG) in appropriate patients. However, the proportion of patients that undergo CABG and or valve surgery (VS) following PCI in the short- and long-term is currently unknown.Methods
We conducted a single-centre retrospective study examining the indications and number of patients requiring CABG and or VS following a successful PCI over a 4 year period 2009–2012. The surgical procedure was categorised as acute (referred within one month of the index PCI), sub-acute (referred between one month and one year of the index PCI) and remote (referred more than one year and up to 4 years following the index PCI). The denominator used for acute and sub-acute was PCI cases performed over a 3 year period 2009–2011, whilst for remote it was 2008–2010.Results
During each 3-year period (2008–2010, 2009–2011), 5244 PCIs were performed at our centre. The total number of patients referred for cardiac surgery post-PCI was 63 (1.2%). Furthermore, the number of patients referred for acute, sub-acute and remote cardiac surgery was 21 (0.4%), 14 (0.26%) and 28 (0.53%) respectively. Within the acute surgery group, 8 patients had extensive 3 vessel disease stabilised with emergency/urgent PCI to allow subsequent CABG, 6 STEMI (1.6% of all primary PCI cases), 2 acute coronary syndromes (ACS) (0.08% of all ACS stented cases). Also within the acute group 10 underwent unsuccessful attempt of a chronic total occlusions (3.3% of all CTOs) and 3 had other technical PCI failures. In the sub-acute group, main reason for surgery was rapid progression in coronary disease to left main equivalent in 8 patients, restenosis in 5 patients (1.6% of all restenosis treated), and 1 missed severe valve disease at initial PCI. Finally, in the remote group, 19 patients underwent VS for progression of their valve disease, 6 progression in coronary disease, 2 restenosis and 1 stent misplaced at a ostium causing chronic valve damage.Conclusion
Our data suggest that the number of patients requiring CABG and or valve surgery following PCI either short- or long-term is very small and the reasons differ with time from the PCI. We hope that these results will provide reassurance and interest to our interventional colleagues.