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ALTARABSHEH ET AL CABG AFTER PERCUTANEOUS INTERVENTION

6. Thielmann M, Leyh R, Massoudy P, et al. Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery. Circulation 2006;114:I441–7. 7. Stevens LM, Khairy P, Agnihotri AK. Coronary artery bypass grafting after recent or remote percutaneous coronary intervention in the Commonwealth of Massachusetts. Circ Cardiovasc Interv 2010;3:460–7. 8. Gaszewska-Zurek E, Zurek P, Kazmierski M, et al. Coronary artery bypass grafting in patients with relatively recent previous stent implantation: three years follow-up results. Cardiol J 2009;16:312–6. 9. Yap CH, Yan BP, Akowuah E, et al. Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery? JACC Cardiovasc Interv 2009;2:758–64. 10. Mannacio V, Di Tommaso L, De Amicis V, et al. Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery. Ann Thorac Surg 2012;93: 1956–62. 11. Chocron S, Baillot R, Rouleau JL, et al. Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization: insights from the IMAGINE study. Eur Heart J 2008;29:673–9. 12. Eifert S, Mair H, Boulesteix AL, et al. Mid-term outcomes of patients with PCI prior to CABG in comparison to patients

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with primary CABG. Vasc Health Risk Manag 2010;6: 495–501. Mehta GS, LaPar DJ, Bhamidipati CM, et al. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting. Surgery 2012;152:5–11. Hassan A, Buth KJ, Baskett RJ, et al. The association between prior percutaneous coronary intervention and short-term outcomes after coronary artery bypass grafting. Am Heart J 2005;150:1026–31. Fukui T, Manabe S, Shimokawa T, Takanashi S. The influence of previous percutaneous coronary intervention in patients undergoing off-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg 2010;16:99–104. Mercado N, Wijns W, Serruys PW, et al. One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: a meta-analysis of individual patient data from randomized clinical trials. J Thorac Cardiovasc Surg 2005;130: 512–9. Taggart DP. Does prior PCI influence the clinical outcome of CABG? EuroIntervention 2009;5(Suppl D):D21–4. Taggart DP. Does prior PCI increase the risk of subsequent CABG? Eur Heart J 2008;29:573–5. Alfonso F, Hernandez C, Perez-Vizcayno MJ, et al. Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis. J Am Coll Cardiol 2000;36: 1549–56.

INVITED COMMENTARY There is accumulating evidence that coronary artery bypass grafting (CABG) in patients with previous percutaneous coronary intervention (PCI) is associated with higher early mortality and major adverse cardiac event rates. This report by Altarabsheh and colleagues [1] provides early and midterm results of CABG after previous PCI, compared with results of CABG without previous PCI, by performance of a meta-analysis of 99,758 patients in 14 studies. The authors demonstrated that early mortality and incidences of myocardial infarction, acute renal failure, and need of intra-aortic balloon pump were higher in patients with previous PCI compared with those without, although the midterm survival rates were comparable between the two groups. Considering the final 5-year outcomes of the SYNTAX trial [2], which demonstrated significantly higher rates of major adverse cardiac and cerebrovascular events, the composite of death/stroke/myocardial infarction, allcause death, myocardial infarction, and repeated revascularization in patients with PCI compared with CABG, a lower midterm survival rate would be expected to occur in CABG patients with previous PCI than in those without previous PCI. The authors may have failed to demonstrate a difference in midterm survival rate because only four studies were included for midterm survival analysis in this meta-analysis. Further analyses of clinical

Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier

outcomes, including late occurrence of cardiac death, myocardial infarction, and reintervention-free survival, especially in patients with intermediate (23-32) or higher (33) SYNTAX score terciles and in diabetic patients, would strengthen the current evidence for the harmful effects of previous PCI on our CABG patients, although current data are not sufficient to enable performance of the meta-analysis. Ki-Bong Kim, MD, PhD Department of Thoracic and Cardiovascular Surgery Seoul National University Hospital 101 Daehak-ro, Jongno-gu Seoul 110-744, Korea e-mail: [email protected]

References 1. Altarabsheh SE, Deo SV, Hang D, et al. Coronary artery bypass grafting after percutaneous intervention has higher early mortality: a meta-analysis. Ann Thorac Surg 2015;99: 2046–52. 2. Head SJ, Davierwala PM, Serruys PW, et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J 2014;35:2821–30.

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Invited Commentary.

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