Thorac Cardiovasc Surg 2020; 68(S 01): S1-S72
DOI: 10.1055/s-0040-1705398
Oral Presentations
Tuesday, March 3rd, 2020
Coronary Heart Disease
Georg Thieme Verlag KG Stuttgart · New York

Staged Complete Hybrid Revascularization in Patients with Multivessel Disease and Acute Myocardial Infarction—A Prospective Angiographic and Clinical Study

P. Grieshaber
1   Gießen, Germany
,
I. Oswald
1   Gießen, Germany
,
M. Albert
2   Stuttgart, Germany
,
A. Sodah
3   Bad Neustadt an der Saale, Germany
,
P. Roth
1   Gießen, Germany
,
A. Diegeler
3   Bad Neustadt an der Saale, Germany
,
D. Sedding
4   Halle (Saale), Germany
,
U. Franke
2   Stuttgart, Germany
,
A. Böning
1   Gießen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2020 (online)

Objectives: Complete revascularization (CR) improves the outcomes after acute myocardial infarction (AMI) without cardiogenic shock. In the presence of multivessel disease, CR after percutaneous coronary intervention (PCI) of the culprit lesion can be accomplished by coronary artery bypass grafting (CABG). Concerns about bleeding, stent complications and elevated perioperative risk limit the acceptance of these staged hybrid approaches. This study aims to evaluate the safety of staged complete hybrid revascularization in a series of consecutive patients.

Methods: Patients undergoing CABG within 90 days after AMI and culprit-lesion PCI from three centers were prospectively included in this observatory study between April 2015 and June 2017. A coronary angiography to evaluate the patency of the implanted coronary stents was conducted on the 5th postoperative day. A 2-year postoperative follow-up was conducted.

Results: A total of 50 patients underwent CABG at a median of 35 days (IQR: 10–40 days) after AMI (45% NSTEMI, 55% STEMI) and culprit PCI (right coronary artery [54%], left circumflex artery [30%], and left anterior descending artery [14%]) using bare metal stents (8.3%), drug-eluting stents (88%), or biodegradable scaffolds (4.2%). All patients had dual-antiplatelet therapy (DAPT) until a median of 3 days preoperatively using acetylsalicylic acid (100%) added by clopidogrel (29%), ticagrelor (42%), or prasugrel (29%). Sixteen patients were bridged with tirofiban. The mean Euroscore II was 2.2%. 52% of procedures were performed on-pump and 48% off-pump. Anatomical CR was reported all cases. Twenty patients (40%) received erythrocyte and 7 patients (14%) platelet transfusions (median: 2). Two patients (4%) needed reexploration for bleeding or tamponade. In the postoperative coronary angiography, 100% of the preoperatively implanted coronary stents were still patent. Thirty-day survival was 100%. The follow-up at 1 year postoperatively showed a survival of 98%. By then, four patients (8.7%) had undergone re-revascularization. At 2 years postoperatively, survival was 94%, and re-revascularization rate was 9.5%.

Conclusion: In patients with AMI and primary PCI of the culprit lesion, the revascularization can be completed using CABG with a very low perioperative risk and excellent mid-term outcomes. The patency of recently implanted coronary stents is not jeopardized by perioperative platelet management including either DAPT discontinuation or bridging with Tirofiban.