ABSTRACT Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups; those with (Group P, protected) and without (Group NP; non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.
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H. Tokoz, S. Sanioglu, O. Sokullu, H. Hasdemir, A. Ozler, S. Aka, I. Yekeler and F. Bilgen, "Semiurgent CABG after Successful PTCA: Should a Patent Stented Coronary Artery Be By-Passed?," Open Journal of Thoracic Surgery, Vol. 2 No. 3, 2012, pp. 46-51. doi: 10.4236/ojts.2012.23011.
 R. S. Loomba and R. Arora, “ST Elevation Myocardial Infarction Guidelines Today: A Systematic Review Exploring Updated ACC/AHA STEMI Guidelines and Their Applications,” American Journal of Therapeutics, Vol. 16, No. 5, 2009, pp. e7-e13. doi:10.1097/MJT.0b013e31818d40df
M. M. Zhu, A. Feit, H. Chadow, M. Alam, T. Kwan and L.T. Clark, “Primary Stent Implantation Compared with Primary Balloon Angioplasty for Acute Myocardial Infarction: A Meta-Analysis of Randomized Clinical Trials,” American Journal of Cardiology, Vol. 88, No. 3, 2001, pp. 297-301. doi:10.1016/S0002-9149(01)01645-9
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, B. Riegel and J. F. Robb, “ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardia
G. L. Ka?uza, J. Joseph, J. R. Lee, M. E. Raizner and A. E. Raizner, “Catasstrophic Outcomes of Noncardiac Surgery Soon after Coronary Stenting,” Journal of the American College of Cardiology, Vol. 35, No. 5, 2000, pp. 1288-1294. doi:10.1016/S0735-1097(00)00521-0
J. M. Alvarez, L. Chen and I. N. Sinclair, “Acute Stent Thrombosis after Off-Pump Coronary Bypass Surgery: A New and Avoidable Complication,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 125, No. 6, 2003, pp. 1544-1546. doi:10.1016/S0022-5223(03)00009-6
P. Zurek, M. Gemel, P. Olszówka, W. Domaradzki, D. Szurlej and S. Wo?, “In-Stent Thrombosis Following Coronary Artery By-Pass Grafting—A Case Report,” Kardiologia Polska, Vol. 59, No. 8, 2003, pp. 142-144.
E. A. Tovar and A. Borsari, “Effects of Surgical Manipulation on Coronary Stents: Should Surgical Strategy Be Altered?” The Annals of Thoracic Surgery, Vol. 63, No. 1, 1997, pp. 37-40. doi:10.1016/S0003-4975(96)00632-7
J. Daemen, E. Boersma, M. Flather, J. Booth, R. Stables, A. Rodriguez, G. Rodriguez-Granillo, W. A. Hueb, P. A. Lemos and P. W. Serruys, “Long-Term Safety and Efficacy of Percutaneous Coronary Intervention with Stenting and Coronary Artery Bypass Surgery for Multivessel Coronary Artery Disease: A Meta-Analysis with 5-Year Patient-Level Data from the ARTS, ERACI-II, MASS-II, and SoS Trials,” Circulation, Vol. 118, 2008, pp. 1146-1154. doi:10.1161/CIRCULATIONAHA.107.752147
D. Fitchett, J. Eikelboom and S. Fremes, “Dual antiplatelet therapy in patients requiring urgent coronary artery bypass grafting surgery: a position statement of the Canadian Cardiovascular Society,” Canadian Journal of Cardiology, Vol. 25, No. 12, 2009, pp. 683-689. doi:10.1016/S0828-282X(09)70527-6
S. Karthik, A. D. Grayson, E. E. McCarron, D. M. Pullan and M. J. Desmond, “Reexploration for Bleeding after Coronary Artery Bypass Surgery: Risk Factors, Outcomes, and the Effect of Time Delay,” The Annals of Thoracic Surgery, Vol. 78, No. 2, 2004, pp. 527-534. doi:10.1016/j.athoracsur.2004.02.088
A. M. Pickett, D. A. Taylor and M. Ackman, “Prolonged Infusion of Eptifibatide as Bridge Therapy between Bare-Metal Stent Insertion and Cardiovascular Surgery: Case Report and Review of the Literature,” Pharmaco-therapy, Vol. 30, No. 4, 2010, pp. 127e-133e. doi:10.1592/phco.30.4.420