Background 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 coronary artery disease who underwent CABG.

Methods In our retrospective study, 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 nonconform (GNC) subgroups, according to the SYNTAX score (2014 European Society of Cardiology [ESC]/European Association for Cardio-Thoracic Surgery [EACTS] guidelines). Thirty days mortality, major adverse cardiac events, and QoL using the European Quality-of-Life–5 Dimensions were evaluated.

Results A total of 997 patients were analyzed, of which 784 underwent CABG without (CO), and 213 individuals with prior PCI (PCF). The latter group consisted of 67 patients being treated in accordance (GCO), and 24 in discordance (GNC) to the 2014 ESC/EACTS guidelines. Reinfarction (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 nonconform subgroup reported poorer health status compared to the 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 preinterventional SYNTAX score (GCO: 18.63 ± 9.81 vs. GNC: 26.67 ± 5.07; p < 0.001).

Conclusion PCI preceding CABG is associated with poorer outcomes such as reinfarction, re-angiography, and re-PCI, but also worse health status and higher rehospitalization. Nevertheless, results were better when PCI was guideline-conformant. This data should impact the Heart Team decision.

背景 心肌血运重建指南定义了经皮冠状动脉介入治疗 (PCI) 或冠状动脉旁路移植术 (CABG) 手术的建议。关于冠状动脉搭桥术（CABG）后再行 PCI 后的长期随访和生活质量 (QoL) 的信息很少。我们研究的目的是评估既往 PCI 对接受 CABG 的稳定性冠状动脉疾病患者的结局和生活质量的影响。

方法 在我们的回顾性研究中，CABG 患者分为：CABG 先行 PCI：先 PCI (PCF) 组和仅 CABG (CO) 组。根据 SYNTAX 评分（2014 年欧洲心脏病学会 [ESC]/欧洲心胸外科协会 [EACTS] 指南），PCF 组进一步分为符合指南 (GCO) 和不符合指南 (GNC) 亚组。使用欧洲生活质量五维度评估了三十天死亡率、主要不良心脏事件和生活质量。

结果 总共分析了 997 名患者，其中 784 名患者接受了冠状动脉旁路移植术（CO），213 名患者既往接受过 PCI（PCF）。后一组包括 67 名按照 2014 年 ESC/EACTS 指南 (GCO) 进行治疗的患者，以及 24 名不符合 (GNC) 治疗的患者。再梗死（PCF：3.8% vs. CO：1.0%；p  = 0.024）、再次血管造影（PCF：17.6% vs. CO：9.0%；p  = 0.004）和重新 PCI（PCF：10.4% vs. CO） ：3.0%；p  < 0.001）在 PCF 患者中观察到的频率更高。此外，与 PCF 组相比，CO 组患者的健康状况更好（CO：72.48 ± 19.31 对比 PCF：68.20 ± 17.86；p  = 0.01）。与符合指南组相比，不符合指南亚组的患者健康状况较差（GNC：64.23 ± 14.56 对比 GCO：73.42 ± 17.66；p = 0.041），并且更有可能需要重新PCI  （GNC：18.8% 对比 GCO：73.42 ± 17.66；p = 0.041） .GCO：2.4%；p  = 0.03)。此外，GNC 患者更有可能出现左主干狭窄（GCO：19.7% vs. GNC：37.5%；p  < 0.001），并且表现出更高的干预前 SYNTAX 评分（GCO：18.63 ± 9.81 vs. GNC：26.67 ± 5.07；p  < 0.001）。

结论 CABG 之前的 PCI 与较差的结局相关，如再梗塞、再次血管造影和再 PCI，但也与较差的健康状况和较高的再住院率相关。尽管如此，当 PCI 符合指南时，结果会更好。这些数据应该会影响心脏团队的决策。