DOI: 10.25881/BPNMSC.2020.12.10.003


Bocharov A.V. 1, Popov L.V.2

1 Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma

2 Pirogov National Medical and Surgical Center, Moscow


Objective: analysis of two-year results of observations of two groups of patients who initially successfully underwent percutaneous coronary intervention of clinical-dependent artery using stents of the 3rd generation with drug coating for acute coronary syndrome with St segment elevation, and then performed complete functional myocardial revascularization by coronary artery bypass grafting or stenting also using stents of the third generation with drug coating.

Materials and methods: the total sample of the study consisted of 110 patients with coronary artery disease and multivessel coronary artery disease the coronary arteries who were performed emergency stenting clinical-related artery in acute coronary syndrome with ST-segment elevation, and subsequently a complete functional revascularization not later than 90 days from the date of completion of the first phase. Complete functional revascularization was performed by methods of coronary artery bypass grafting or stenting with the use of stents 3-generation drug-eluting and biodegradable polymer. Patients of both groups were followed up after complete revascularization on a quarterly basis on an outpatient basis for 2 years. The end points of observation in both groups were cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, repeated revascularization and combined macce end point (cardiovascular mortality, myocardial infarction, acute cerebrovascular accident, repeated revascularization).

Results: there were no statistically significant differences between the groups in clinical, demographic and operational characteristics, except for the frequency of a history of myocardial infarction, which was significantly more common in the group of coronary artery bypass grafting. The analysis of the results revealed significant differences between the groups in the frequencies of revascularization and, accordingly, the combined macce point, which were significantly higher in the stenting group.

Keywords: acute coronary syndrome, coronary heart disease, coronary artery bypass grafting, drug-eluting stent.


1. Cook S, Walker A, Hugli O, et al. Percutaneous coronary interventions in Europe: prevalence, numerical estimates, and projections based on data up to 2004. Clin Res Cardiol. 2007;96(6):375–382. Doi: 10.1007/s00392-007-0513-0.

2. Shahabuddin S, Sami S, Ansari J, et al. Coronary artery bypass grafting after percutaneous coronary intervention. J Coll Physicians Surg Pak. 2012;22:340–341.

3. Gilbert CS, James T, Peter DS, et al. Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery? JACC Cardiovasc Interv. 2009;2(8):758–764. Doi: 10.1016/j.jcin.2009.04.018.

4. Tran HA, Barnett SD, Hunt SL, et al. The effect of previous coronary artery stenting on short- and intermediate-term outcome after surgical revascularization in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2009;138(2):316–323. Doi: 10.1016/j.jtcvs.2009.03.004.

5. Taggart DP. Does prior PCI increase the risk of subsequent CABG? Eur Heart J. 2008;29(5):573–575. Doi: 10.1093/eurheartj/ehm645.

6. Davis PK, Parascondola SA, Miller CA, et al. Mortality of coronary artery bypass grafting before and after the advent of angioplasty. Ann Thorac Surg. 1989;47(4):493–497. Doi: 10.1016/0003-4975(89)90422-0.

7. van den Brule JM, Noyez L, Verheugt FW. Risk of coronary surgery for hospital and early morbidity and mortality after initially successful percutaneous intervention. Interact Cardiovasc Thorac Surg. 2005;4(2):96–100. Doi: 10.1510/icvts.2004.093104.

8. Johnson RG, Sirois C, Thurer RL, et al. Predictors of CABG within one year of successful PTCA: a retrospective, case-control study. Ann Thorac Surg. 1997;64(1):3–7. Doi: 10.1016/s0003-4975(97)00451-7.

9. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961–972. Doi: 10.1056/NEJMoa0804626.

10. Thuijs DJ, Mohr FW, Serruys PW, et al. 10-year survival after bypass surgery versus drug-eluting stents: preliminary results of the randomized SYNTAX extended survival study «SYNTAXES». Proceedings of the TCT 2018; 2018 Sep 21; San Diego, USA.

11. Kappetein AP. Optimal revascularization strategy with three-vessel disease and/or left main disease. The 2-year outcomes of the SYNTAX trial. Proceedings of the ESC Congress 2009; 2009 Sep 2; Barcelona, Spain.

12. 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(5):1026–1031. Doi: 10.1016/j.ahj.2005.03.035.

13. Bonaros N, Vill D, Wiedemann D, et al. Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in patients with previous percutaneous intervention. Eur J Cardiothorac Surg. 2011;39(6):e164–e169. Doi: 10.1016/j.ejcts.2011.01.054.

14. Eifert S, Mair H, Boulesteix A, et al. Mid-term outcomes of patients with PCI prior to CABG in comparison to patients with primary CABG. Vasc Health Risk Manag. 2010;6:495–501. Doi: 10.2147/vhrm.s8560.

15. 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(5):673–679. Doi: 10.1093/eurheartj/ehn026.

16. Rao C, Stanbridge Rde L, Chikwe J, et al. Does previous percutaneous coronary stenting compromise the long-term efficacy of subsequent coronary artery bypass surgery? A microsimulation study. Ann Thorac Surg. 2008;85(2):501–507. Doi: 10.1016/j.athoracsur.2007.09.036.

17. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary disease. EuroIntervention. 2005;1:219–227.

18. Biancari F, Mariscalo G, Rubino AS, et al. The effect of prior percutaneous coronary intervention on the immediate and late outcome after coronary bypass grafting: systematic review and meta-analysis. Heart Lung Vessel. 2014;6(4):244–252.

19. Elassy SM. Impact of previous stenting on the outcome of CABG in multivessel disease. Austin Cardio & Cardiovasc Case Rep. 2016;1(1):1005.

20. Alassal MA, Elrakhawy H, Hassenein M, et al. Comparison of clinical outcomes among patients undergoing coronary artery bypass grafting (CABG) with or without prior percutaneous coronary intervention (PCI). J Clin Exp Cardiolog. 2014;6(10):405. Doi: 10.4172/2155-9880.1000405.

For citation

Bocharov A.V., Popov L.V. Comparison of surgical and endovascular strategies for revascularization of the myocardium in patients with ischemic heart disease and multivessel coronary artery disease with prior stenting of clinical-related artery in acute coronary syndrome with ST-segment elevation according to the results of two years observation. Bulletin of Pirogov National Medical & Surgical Center. 2020;1(15):23-26. (In Russ.)