The association between prior percutaneous coronary intervention and short-term outcomes after coronary artery bypass grafting.

Division of Cardiac Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
American heart journal (Impact Factor: 4.65). 11/2005; 150(5):1026-31. DOI: 10.1016/j.ahj.2005.03.035
Source: PubMed

ABSTRACT Increasingly, patients are being referred for coronary artery bypass grafting (CABG) for management of symptoms after prior percutaneous coronary intervention (PCI). In this study, we assessed the impact of prior PCI on inhospital mortality after CABG.
Perioperative data were collected on patients who underwent first-time CABG at 2 surgical centers. Patients who underwent PCI and CABG during the same admission were excluded. Patients with prior PCI were compared with patients with no prior PCI, and the risk-adjusted impact of prior PCI on inhospital mortality after CABG was determined using both multivariate techniques and propensity score matching techniques.
Six thousand thirty-two patients met inclusion criteria. Patients with prior PCI were less likely to be between the ages of 70 and 80 (P < .0001), to have an ejection fraction <0.40 (P < .0001), and to have 3-vessel/left main disease (P < .0001). They were, however, more likely to have Canadian Cardiovascular Society class IV symptoms (P < .0001) and to have an urgent status (P = .02). Rates of inhospital mortality after CABG were higher in patients with prior PCI (3.6% vs 2.3%, P = .02). Using multivariate techniques, prior PCI emerged as an independent predictor of postoperative inhospital mortality (odds ratio 1.93, P = .003). When patients with prior PCI were matched to patients with no prior PCI using propensity scores, inhospital mortality remained higher among patients with prior PCI (3.6% vs 1.7%, P = .01).
Patients with prior PCI presented for CABG with less comorbidity and diminished coronary disease; yet, they had more advanced symptoms and greater urgency. After adjusting for these differences, prior PCI emerged as an independent predictor of inhospital mortality after CABG.

  • Source
    JACC. Cardiovascular Interventions 09/2009; 2(8):765-6. · 1.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We hypothesized that the incidence of previous percutaneous coronary intervention (PCI) is increasing and that prior PCI influences patient morbidity and mortality after coronary artery bypass grafting (CABG). A total of 34,316 patients underwent isolated CABG operations at 16 different statewide, institutions from 2001 to 2008. Patients were stratified into prior PCI (n = 4346; 12.7%) and no prior PCI (n = 29,970). Patient risk factors, intraoperative variables, and outcomes were compared by univariate and multivariate analyses. The incidence of prior PCI in CABG has risen from <1% to 22.0% from 2001 to 2008 (P < .001). Prior PCI patients were younger (P < .001) and more commonly had previous myocardial infarction (P < .001), but less commonly had heart failure (P < .001). The operative mortality was similar between groups (2.3% vs 1.9%; P = .13). Prior PCI patients had more major complications (15.0% vs 12.0%; P < .001), longer hospitalization (P = .01), and higher readmission rates (P = .01). Importantly, by multivariate analyses, prior PCI was not associated with mortality, but was an independent predictor of major complications after CABG (odds ratio, 1.15; P = .01). The incidence of prior PCI in patients undergoing CABG is increasing. Previous PCI is associated with a higher risk of major complications, greater hospital length of stay, and higher readmission rates after CABG.
    Surgery 04/2012; 152(1):5-11. · 3.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of our study was to compare the early and long-term outcomes of patients undergoing off-pump coronary artery bypass grafting (CABG) with and without previous coronary stents. Between September 2004 and September 2011, 269 patients with previous stents underwent first-time isolated off-pump CABG. These patients were compared with 897 patients without previous stent. A propensity score-matching analysis was performed to compare early and late outcomes between the groups. Mean follow-up time was 43.4 months after surgery. Patients with previous stents were more likely to be men (85.9% in the stent group vs 79.4% in the no-stent group; P = .022) and more likely to have prior myocardial infarction (60.2% vs 36.8%; P < .001). Mean number of anastomoses was lower in patients with previous stents than in patients without previous stents (4.0 vs 4.2; P = .037). There was no difference in the use of bilateral internal thoracic artery graft between the groups (88.8% vs 89.1%; P > .999). After propensity adjustment for preoperative characteristics, both operative death (0.7% vs 1.5%; P = .414) and the major complications rates (7.8% vs 7.5%; P = .869) were similar between the groups. The actuarial survival rate at 7 years was not different between the groups (87.2% ± 3.2% vs 84.8% ± 2.9%; P = .470). Furthermore, freedom from major adverse cardiac and cerebrovascular events at 7 years were similar between the groups (78.9% ± 3.8% vs 77.6% ± 3.3%; P = .811). Previous coronary stents do not increase early and long-term morbidity or mortality in patients undergoing off-pump CABG.
    The Journal of thoracic and cardiovascular surgery 02/2014; · 3.41 Impact Factor


Available from
Jul 10, 2014