Percutaneous Catheter Interventions Followed by Coronary Artery Bypass Grafting
Primum Non Nocere
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The results of the SYNTAX trial (The Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery),1 the FREEDOM trial (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease),2 and other studies are providing clarity and even growing consensus among cardiologists and surgeons about the relative roles of percutaneous catheter interventions (PCI) versus coronary artery bypass grafting (CABG) for coronary revascularization. However, there remains a concern, especially among cardiac surgeons, that some patients with prior PCI may be at increased risk of poor outcomes when undergoing subsequent CABG surgery.3,4 In a report in this issue of Circulation: Cardiovascular Interventions from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting), Mariscalco et al5 acknowledge that the clinical impact of prior PCI in patients who subsequently require CABG remains unsettled. The authors queried the recently established voluntary registry of CABG procedures undertaken at 16 European centers, designated as E-CABG, hoping to answer this persisting concern about possible risks associated with prior PCI at subsequent CABG operations. In addition, they undertook a meta-analysis of publications reporting on outcomes after CABG in patients with prior PCI.
See Article by Mariscalco et al
This E-CABG registry was posted on ClinicalTrials.gov site in December 2014 (URL: http://www.clinicaltrials.gov. Unique identifier: NCT02319083), and the study protocol was described by Biancari et al6 in 2015. The 16 participating centers represent university and community hospitals in 6 European countries. E-CABG processes are described as involving thorough prospective data collection on all patients with CABG including presenting clinical status and immediate postoperative adverse events. This current report seems to be the first published analysis of CABG outcomes based on a review of more than 3700 …