Multiple percutaneous coronary interventions may negatively impact cardiac remodelling after bypass surgery

OBJECTIVES: Many patients undergo percutaneous coronary intervention (PCI) multiple times before being referred for coronary artery bypass grafting (CABG), in which bypass grafts are often anastomosed to small distal targets with higher risk of graft failure. We aimed to assess whether multiple PCIs adversely affect the long-term outcomes of patients who undergo CABG subsequently. METHODS: A cohort of 368 patients with no history of PCI underwent initial isolated CABG between 2003 and 2013 (no PCI group). Ninety-seven patients who had undergone PCI 2 or more times preoperatively during the same period constituted the multiple PCI group. After propensity score matching, the group outcomes were compared. RESULTS: There were no significant differences in the 10-year all-cause mortality and major adverse cardiac and cerebrovascular event rates in both groups. Although the left ventricular end-diastolic dimension in the multiple PCI group did not change markedly (from 48.0 +/- 6.0 to 47.2 +/- 7.9 mm; P = 0.25), it decreased significantly in the no PCI group (from 48.3 +/- 6.1 to 44.9 +/- 9.1 mm; P < 0.001). The left ventricular end-systolic dimension in the no PCI group decreased significantly (from 34.1 +/- 8.7 to 31.4 +/- 8.6 mm; P = 0.024), while it in the multiple PCI group did not (from 33.6 +/- 8.3 to 32.7 +/- 8.6 mm; P = 0.21). CONCLUSIONS: For complex coronary artery disease, early surgical intervention could be considered with respect to postoperative left ventricular remodelling during the long-term follow-up.