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Previous percutaneous coronary intervention as risk factor for coronary artery bypass grafting

Luiz Augusto Ferreira Lisboa1, Omar Asdrúbal Mejia, Luís Alberto Dallan

  • 1Instituto do Coração do Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil. lisboa@cardiol.br

Arquivos Brasileiros De Cardiologia
|June 28, 2012
PubMed

Insights

Patients with prior percutaneous coronary intervention (PCI) face higher in-hospital mortality after coronary artery bypass grafting (CABG). This finding highlights the need to consider previous PCI when planning CABG for multivessel coronary artery disease.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Percutaneous coronary intervention (PCI) is increasingly used as an initial treatment for chronic coronary artery disease.
  • A growing number of patients undergoing coronary artery bypass grafting (CABG) have a history of prior PCI, including coronary stents.

Purpose of the Study:

  • To evaluate the impact of previous percutaneous coronary intervention (PCI) on in-hospital mortality following coronary artery bypass grafting (CABG).
  • To assess this impact specifically in patients diagnosed with multivessel coronary artery disease.

Main Methods:

  • A comparative study of 1099 patients undergoing CABG between May 2007 and June 2009.
  • Patients were divided into two groups: those with no prior PCI (n=938) and those with prior PCI (n=161).
  • Logistic regression and propensity score matching were employed to analyze the risk-adjusted impact of previous PCI on in-hospital mortality.

Main Results:

  • Patients with prior PCI were more likely to present with unstable angina.
  • In-hospital mortality after CABG was significantly higher in the prior PCI group (9.3%) compared to the no-PCI group (5.1%).
  • Previous PCI was identified as an independent predictor of in-hospital mortality post-CABG, with an odds ratio of 1.94 (P=0.044), comparable to diabetes.

Conclusions:

  • Previous percutaneous coronary intervention (PCI) is an independent risk factor for in-hospital mortality after coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease.
  • This increased risk must be considered when PCI is chosen as the initial revascularization strategy for patients with more severe coronary artery disease.
Abstract

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