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Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery
Cheng-Hon Yap1, Bryan P Yan, Enoch Akowuah
1Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia. chenghonyap@hotmail.com
Insights
Prior percutaneous coronary intervention (PCI) does not increase short- or mid-term mortality after coronary artery bypass graft surgery (CABG). Patients with prior PCI experience similar outcomes to those without, indicating good results are achievable.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- An increasing number of patients undergoing coronary artery bypass graft surgery (CABG) have a history of percutaneous coronary intervention (PCI).
- Understanding the impact of prior PCI on CABG outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the association between previous percutaneous coronary intervention (PCI) and outcomes following coronary artery bypass graft surgery (CABG).
Main Methods:
- Analysis of consecutive first-time isolated CABG procedures from a large surgical database (June 2001-May 2008).
- Utilized logistic regression, propensity score analysis, and Cox regression to assess risk-adjusted impact of prior PCI on in-hospital and mid-term mortality.
- Evaluated major adverse cardiac events in patients with and without prior PCI.
Main Results:
- Out of 13,184 CABG patients, 1,457 had prior PCI.
- No significant difference in unadjusted in-hospital mortality (1.65% vs. 1.55%) or major adverse cardiac events (3.0% vs. 3.0%) between groups.
- Risk-adjusted analyses showed prior PCI was not a predictor of in-hospital or 6-year mid-term mortality.
Conclusions:
- Prior PCI is not associated with increased short- or mid-term mortality after CABG in this large registry study.
- Patients undergoing CABG with a history of prior PCI can achieve good clinical outcomes.
- These findings support the continued management of complex coronary artery disease through both PCI and CABG.
Objectives:
To determine the association between previous percutaneous coronary intervention (PCI) and results after coronary artery bypass graft surgery (CABG).
Background:
Increasing numbers of patients undergoing CABG have previously undergone PCI.
Methods:
We analyzed consecutive first-time isolated CABG procedures within the Australasian Society of Cardiac and Thoracic Surgeons Database from June 2001 to May 2008. Logistic regression and propensity score analyses were used to assess the risk-adjusted impact of prior PCI on in-hospital mortality and major adverse cardiac events. Cox regression model was used to assess the effect of prior PCI on mid-term survival.
Results:
Of 13,184 patients who underwent CABG, 11,727 had no prior PCI and 1,457 had prior PCI. Mean follow-up was 3.3 +/- 2.1 years. Patients without prior PCI had a higher EuroSCORE value (4.4 +/- 3.3 vs. 3.6 +/- 3.0, p < 0.001), were older, and more likely to have left main stem stenosis and recent myocardial infarction. There was no difference in unadjusted in-hospital mortality (1.65% vs. 1.55%, p = 0.78) or major adverse cardiac events (3.0% vs. 3.0%, p = 0.99) between patients with or without prior PCI. After adjustment, prior PCI was not a predictor of in-hospital (odds ratio: 1.22, 95% confidence interval [CI]: 0.76 to 2.0, p = 0.41) or mid-term mortality at 6-year follow-up (hazard ratio: 0.94, 95% CI: 0.75 to 1.18, p = 0.62).
Conclusions:
In this large registry study, prior PCI was not associated with increased short- or mid-term mortality after CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI.
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