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Increased mortality and perioperative complications in patients with previous elective percutaneous coronary
Nikolaos Bonaros1, Diana Hennerbichler, Guy Friedrich
1Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. nikolaos.bonaros@i-med.ac.at
Insights
Patients with prior percutaneous coronary intervention (PCI) experience worse outcomes after coronary artery bypass grafting (CABG). This includes increased mortality, major adverse cardiac events, and complications, necessitating careful risk stratification for these individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- The impact of prior percutaneous coronary intervention (PCI) on outcomes following coronary artery bypass grafting (CABG) is not well-established.
- Understanding this relationship is crucial for optimizing patient management and risk assessment.
Purpose of the Study:
- To evaluate whether undergoing elective PCI prior to CABG affects perioperative outcomes.
- To compare the incidence of mortality, major adverse cardiac events, and complications between patients with and without a history of prior PCI.
Main Methods:
- A retrospective analysis of 4412 patients undergoing first-time open-heart surgery between 2002 and 2007.
- 306 patients with elective PCI within 24 months before isolated CABG (group 1) were compared to 452 matched controls without prior PCI (group 2).
- Outcomes assessed included 30-day mortality, major adverse cardiac events, and perioperative complications.
Main Results:
- Patients with prior PCI had significantly higher 30-day mortality (4.4% vs 2.4%) and major adverse cardiac events (7.9% vs 4.3%).
- Increased rates of bleeding complications (5.9% vs 3.8%), acute renal failure (5.9% vs 2.7%), and need for renal replacement therapy (3.6% vs 1.7%) were observed in the prior PCI group.
- The prior PCI group also required more blood product transfusions (1.70 vs 0.61 units).
Conclusions:
- A history of elective percutaneous coronary intervention is associated with poorer perioperative outcomes after coronary artery bypass grafting.
- These findings highlight the importance of considering prior PCI in the risk stratification process for patients undergoing elective CABG.
Objective:
The relationship between previous percutaneous coronary intervention and perioperative outcome after coronary artery bypass grafting remains undetermined. The aim of the study was to investigate whether previous elective percutaneous coronary intervention influences the outcome of elective coronary artery bypass grafting.
Methods:
Between 2002 and 2007, 4412 consecutive patients underwent first-time open surgery at the Innsbruck Medical University. After excluding patients with a history of emergency percutaneous coronary intervention, we isolated 306 patients with elective percutaneous coronary intervention during the last 24 months before isolated coronary artery bypass grafting (group 1). Those patients were compared with 452 consecutive age-, gender-, and EuroSCORE-matched patients without a history of percutaneous coronary intervention (group 2), in terms of 30-day mortality, major adverse cardiac events, and perioperative complications.
Results:
Both groups were comparable concerning preoperative linear EuroSCORE (group 1: 4.83 +/- 0.18, group 2: 4.72 +/- 0.14, P = .63). Patients who underwent previous elective percutaneous coronary intervention before coronary artery bypass grafting had an increase in perioperative mortality (group 1: 4.4% vs group 2: 2.4%, P < .001) and major adverse cardiac events (group 1: 7.9% vs 4.3%, P < .001). In addition, the incidence of bleeding complications (group 1: 5.9% vs group 2: 3.8%, P = .017) and the number of blood products (group 1: 1.70 +/- 0.31 vs 0.61 +/- 0.17, P < .001) used were higher in patients of group 1. A higher incidence of acute renal failure (5.9% vs 2.7%, P = .025) and renal replacement therapy (3.6% vs 1.7%, P = .03) was observed in patients of group 1.
Conclusion:
Patients with a history of elective percutaneous coronary intervention before referral to coronary artery bypass grafting have a worse perioperative outcome in terms of mortality, major adverse cardiac events, and perioperative complications compared with patients without a history of percutaneous coronary intervention. This fact should be considered in risk stratification for patients who are scheduled for elective coronary artery bypass grafting.
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