Einfluss einer präoperativen perkutanen Koronarintervention auf den Therapieerfolg von Patienten nach koronarer Bypassoperation

Abstract

Eine perkutane Koronarintervention vor koronarer Bypasschirurgie hat keinen direkten Einfluss auf das Überleben der Patienten. Patienten mit präoperativer PCI gaben einen schlechteren Gesundheitszustand im EQ-5D-Fragebogen an. Zu beobachten war außerdem, dass Patienten mit präoperativer PCI häufiger postoperativ Myokardinfarkte erlitten, sowie re-koronarangiographiert und dann auch re-interveniert werden mussten. Patienten, die zudem eine leitlinienkonformen PCI erfahren hatten vor CABG, gaben eine bessere Lebensqualität an und wurden signifikant seltener re-koronarinterveniert. Die Wichtigkeit der leitliniengerechten Therapie und vor allem die Bedeutung der Entscheidung zur Revaskularisierungsstrategie in einer gemeinsamen Herzkonferenz wird durch diese Dissertationsarbeit deutlich.

<strong>Follow-up and outcome after coronary bypass surgery preceded by coronary stent implantation</strong> <br /> <strong>Background: </strong> Guidelines on myocardial revascularization define recommendations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Only little information exists on long-term follow-up and quality of life (QoL) after CABG preceded by PCI. The aim of our study was to evaluate the impact of prior PCI on outcome and QoL in patients with stable CAD who underwent CABG. <br /> <strong>Methods: </strong> In our retrospective study, 997 CABG-patients were divided in: CABG preceded by PCI: PCI-First (PCF)-, and CABG- only (CO)-groups. The PCF-group was further divided in guideline-conform (GCO) and guideline non-conform (GNC) sub- groups, according to the SYNTAX-Score (2014 ESC-guidelines). Thirty-days mortality, major adverse cardiac events and quality- of-life using EQ-5D were evaluated. <br /> <strong>Results: </strong> Re-infarction (PCF: 3.8% vs. CO: 1.0%; p=0.024), re-angiography (PCF: 17.6% vs. CO: 9.0%; p=0.004), and re-PCI (PCF: 10.4% vs. CO: 3.0%; p<0.001) were observed more frequently in PCF-patients. Also, patients reported better health-status in the CO- compared to PCF-group (CO: 72.48±19.31 vs. PCF: 68.20±17.86; p=0.01). Patients from the guideline non-conform sub- group reported poorer health-status compared to guideline-conform group (GNC: 64.23±14.56 vs. GCO: 73.42±17.66; p=0.041) and were more likely to require re-PCI (GNC: 18.8% vs. GCO: 2.4%; p=0.03). Also, GNC-patients were more likely to have left main stenosis (GCO: 19.7% vs. GNC: 37.5%; p<0.001) and showed higher pre-interventional SYNTAX-Score (GCO: 18.63±9.81 vs. GNC: 26.67±5.07; p<0.001). <br /> <strong>Conclusions: </strong> PCI preceding CABG is associated with worse health-status and higher re-hospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart-Team decision.