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Ann Thorac Surg 2006;82:795-801
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery

^a Departments of Surgery and Cardiology, VA Medical Center and University of Minnesota, Minneapolis, Minnesota
^b The Cooperative Studies Program Coordinating Center and the Division of Peripheral Vascular Surgery, VA Hospital, Hines, Illinois
^c Division of Cardiology, VA Medical Center, Portland, Oregon
^d Division of Cardiology, VA Medical Center, Tucson, Arizona
^e Division of Vascular Surgery, VA Medical Center, Denver, Colorado

Accepted for publication March 23, 2006.

^_* Address correspondence to Dr Ward, VA Medical Center (112), One Veterans Dr, Minneapolis, MN 55417 (Email: wardx020{at}umn.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: Among patients in need of coronary revascularization before an elective vascular operation, the value of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in preventing perioperative myocardial infarctions is uncertain. We hypothesized that more complete revascularization would improve outcomes after vascular surgery.

METHODS: In this Veterans Affairs Cooperative trial involving 18 medical centers, 222 patients underwent elective vascular surgery after coronary revascularization. The mode of coronary revascularization was selected at each site by the local investigators (CABG in 91 patients and PCI in 131 patients). The vascular surgical indications were similar in both groups.

RESULTS: There were 2 deaths in the CABG group (2.2%) and 5 deaths in the PCI group (3.8%; p = 0.497) after the vascular procedure. There were fewer perioperative myocardial infarctions after the vascular operation in CABG patients (6.6%) than in PCI patients (16.8%; p = 0.024), despite more diseased vessels in the CABG group (3.0 ± 1.3 versus 2.2 ± 1.4, respectively; p < 0.001). The completeness of revascularization (defined as the number of coronary artery vessels revascularized relative to the total number of vessels with a stenosis 70%) in patients in the CABG and PCI groups was 117% ± 63% and 81% ± 57%, respectively (p < 0.001). Hospital length of stay in CABG versus PCI patients was 6 (4, 8) and 7 (4, 10) days, respectively (p = 0.078).

CONCLUSIONS: Among patients receiving multivessel coronary artery revascularization as prophylaxis for elective vascular surgery, patients having a CABG had fewer myocardial infarctions and tended to spend less time in the hospital after the vascular operation than patients having a PCI. More complete revascularization accounted for the intergroup differences.

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