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The association between prior percutaneous coronary intervention and short-term outcomes after coronary artery bypass
Ansar Hassan1, Karen J Buth, Roger J F Baskett
1Division of Cardiac Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Prior percutaneous coronary intervention (PCI) increases in-hospital mortality risk following coronary artery bypass grafting (CABG). This finding holds true even after accounting for patient differences, highlighting PCI as an independent predictor of adverse outcomes post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Increasing numbers of patients undergo coronary artery bypass grafting (CABG) after prior percutaneous coronary intervention (PCI).
- The impact of prior PCI on outcomes following CABG requires thorough investigation.
Purpose of the Study:
- To assess the effect of prior percutaneous coronary intervention (PCI) on in-hospital mortality rates among patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- A comparative analysis of perioperative data from patients undergoing first-time CABG at two surgical centers.
- Exclusion of patients who underwent PCI and CABG during the same hospital admission.
- Risk-adjusted analysis using multivariate techniques and propensity score matching to compare outcomes between patients with and without prior PCI.
Main Results:
- Patients with prior PCI were less likely to have comorbidities like reduced ejection fraction or multi-vessel disease but more likely to present with advanced symptoms and urgent status.
- In-hospital mortality rates after CABG were significantly higher in the prior PCI group (3.6% vs. 2.3%).
- Prior PCI was identified as an independent predictor of in-hospital mortality (OR 1.93, P=0.003) and remained significant after propensity score matching (3.6% vs. 1.7%, P=0.01).
Conclusions:
- Despite presenting with fewer comorbidities, patients with prior PCI undergoing CABG experience higher in-hospital mortality.
- Prior PCI is an independent risk factor for in-hospital mortality after CABG, even after adjusting for clinical differences.
- These findings underscore the importance of considering prior PCI when evaluating surgical risk for CABG.
Background:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
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