Early Post-operative Results of Patients after Coronary Artery Surgery Following In-stent Restenosis versus those after Primary Coronary Artery Surgery

Background: Coronary artery bypass grafting (CABG) remains a vital revascularization strategy, especially in patients with failed percutaneous coronary interventions (PCI) due to in-stent restenosis (ISR).  
Objectives: This study aimed to compare early postoperative outcomes of CABG after In-stent restenosis (ISR) versus primary CABG and to identify risk factors contributing to adverse outcomes in ISR patients.
Patients and methods: A prospective cohort study included 144 patients undergoing on-pump CABG from July 2022 to December 2023 at two tertiary centers. Patients were divided into Group A (primary CABG, n=72) and Group B (CABG after ISR, n=72). Preoperative, intraoperative, and postoperative parameters were collected and analyzed.
Results: Early postoperative complications, including perioperative myocardial infarction (MI), arrhythmias, re-exploration due to bleeding, renal impairment requiring dialysis during hospitalization, prolonged intubation (>72 hours) and perioperative mortality were significantly more frequent in Group B (patients undergoing CABG after in-stent restenosis [ISR]) compared to Group A (patients undergoing primary CABG). Notably, perioperative mortality was higher in Group B (8.3%) than in Group A (2.7%).
Conclusion: CABG following ISR is associated   with increased early postoperative morbidity and mortality. Prior PCI may negatively impact surgical outcomes due to altered vascular anatomy and inflammatory response. CABG should be considered carefully in ISR patients with high-risk profiles.