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Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting
Gaurav S Mehta1, Damien J LaPar, Castigliano M Bhamidipati
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Insights
The incidence of previous percutaneous coronary intervention (PCI) before coronary artery bypass grafting (CABG) is rising. While not impacting mortality, prior PCI increases major complications, hospital stays, and readmissions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- The frequency of prior percutaneous coronary intervention (PCI) among patients undergoing coronary artery bypass grafting (CABG) is increasing.
- The impact of previous PCI on morbidity and mortality following CABG requires further investigation.
Purpose of the Study:
- To evaluate the trend in prior PCI among CABG patients.
- To determine if prior PCI influences outcomes, including morbidity and mortality, after CABG.
Main Methods:
- A retrospective analysis of 34,316 isolated CABG operations performed between 2001 and 2008.
- Patients were categorized into groups with and without prior PCI.
- Univariate and multivariate analyses were used to compare risk factors, intraoperative variables, and outcomes.
Main Results:
- The incidence of prior PCI in CABG patients rose significantly from <1% to 22.0% between 2001 and 2008.
- Patients with prior PCI had more major complications (15.0% vs 12.0%), longer hospitalizations, and higher readmission rates.
- Prior PCI was not associated with increased operative mortality but was an independent predictor of major complications (OR, 1.15; P = .01).
Conclusions:
- The utilization of prior PCI in patients undergoing CABG has demonstrably increased.
- Previous PCI is linked to a higher risk of major complications, extended hospital stays, and increased readmission rates post-CABG.
Background:
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).
Methods:
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.
Results:
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).
Conclusion:
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.
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