Coronary artery bypass grafting (CABG) after successful percutaneous transluminal coronary angioplasty (PTCA): is PTCA a risk for CABG?

We studied patients who underwent a coronary artery bypass grafting (CABG) procedure with previous percutaneous transluminal coronary angioplasty (PTCA). Forty patients had undergone successful PTCA, and required subsequent CABG, between January 1993 and June 1996 (Group I). These patients were matched with 40 patients surgically revascularized without previous PTCA at the same term (Group II). There were no statistical differences among sex, diabetes mellitus, hypertension, family history, smoking, hypercholesterolemia and prior myocardial infarction within the groups. The mean ages were 50.7+/-9.4 and 54.7+/-7.7 years, respectively, in Group I and Group II (P = 0.02). Preoperative mean ejection fraction values were 59+/-5% in Group I and 56+/-7% in Group II (P = 0.01). The mean follow-up period was 21.0+/-9.8 months (1-38 months) for both groups. CABG operations were performed 11.4+/-6.0 months after PTCA. Number of grafts were 2.1+/-0.7 and 2.3+/-0.8 per patient in Group I and Group II, respectively. Mean aortic cross-clamping times were 18+/-3 and 17+/-4 min/graft (P = 0.01) and cardiopulmonary bypass (CPB) times were 34+/-7 and 29+/-7 min for Group I and Group II, respectively, (P = 0.0001). The duration of hospital stay were 9.1+/-2.5 days for Group I and 8.0+/-1.1 days for Group II (P = 0.008). Freedom from angina at the end of 3 years was 82.5% and 87.5% for Group I and Group II, respectively. One early and two late deaths occured in Group I. One early death and one late death occured in the other group. Survival rates for three years were 92.5% and 95% in Group I and in Group II, respectively. In conclusion, the method of initial revascularization procedure should be considered carefully, as markers of more severe disease may indicate primary CABG and avoidance of an initial PTCA. The initial PTCA may complicate the operation and may increase postoperative morbidity and mortality.