Yonsei Med J.  2018 Jun;59(4):480-488. 10.3349/ymj.2018.59.4.480.

Effects of Coronary Artery Revascularization with a Polymer-Free Biolimus A9–Coated BioFreedom Stent Versus Bypass Surgery before Noncardiac Surgery

• Kim K
• Kim C
• Kim BK
• Jang JY
• Her AY
• Kim S
• Hong SJ
• Ahn CM
• Kim JS
• Ko YG
• Choi D
• Hong MK
• Jang Y

• KMID: 2410902
• DOI: http://doi.org/10.3349/ymj.2018.59.4.480

Abstract

PURPOSE
The present study aimed to evaluate the efficacy and safety of polymer-free drug-coated BioFreedom stent implantation in comparison to coronary artery bypass graft (CABG) before major noncardiac surgery.
MATERIALS AND METHODS
In a multicenter registry, 55 patients required revascularization before major noncardiac surgery that should not be delayed >6 months. Of them, 27 underwent BioFreedom stent implantation and 28 underwent CABG. Primary outcomes included rate of noncardiac surgery, time from revascularization to noncardiac surgery, and occurrence of composite outcomes (all-cause death, myocardial infarction, stent thrombosis, stroke, repeat revascularization, or major bleeding).
RESULTS
The rate of major noncardiac surgery was significantly higher in the BioFreedom group (92.6%) than in the CABG group (64.3%; p=0.027). Time from revascularization to noncardiac surgery was significantly shorter in the BioFreedom group (38.0 days) than in the CABG group (73.0 days; p=0.042). During the hospitalization for revascularization period, the occurrence of primary outcomes did not differ between the groups. However, the BioFreedom group showed a shorter hospitalization period and lower total treatment cost than the CABG group. During the hospital stay for noncardiac surgery, the occurrence of composite outcome was not significantly different between groups (4% vs. 0%; p>0.999): stroke occurred in only 1 case, and there were no cases of death or stent thrombosis in the BioFreedom group.
CONCLUSION
This study demonstrated that BioFreedom stenting as a revascularization strategy before major noncardiac surgery might be feasible and safe in selected patients with less severe coronary artery diseases.

Keyword

Percutaneous coronary intervention; drug-coated stent; coronary artery bypass; preoperative care

MeSH Terms

Coronary Artery Bypass
Coronary Artery Disease
Coronary Vessels*
Drug-Eluting Stents
Health Care Costs
Hospitalization
Humans
Length of Stay
Myocardial Infarction
Percutaneous Coronary Intervention
Preoperative Care
Stents*
Stroke
Thrombosis
Transplants

Figure

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  Fig. 1 Study flow. PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft.

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  Fig. 2 Independent determinants of PCI vs. CABG. PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; LV, left ventricular; SYNTAX, Synergy between PCI with Taxus and Cardiac Surgery; OR, odds ratio; CI, confidence interval.

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  Fig. 3 Comparison of various time intervals and rates of noncardiac surgery performed between the BioFreedom group (A) and the coronary artery bypass graft (CABG) group (B). The curves indicate the rates of noncardiac surgery finally performed and the reasons for cancellation (black arrows) in either group.

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