[Correlation between previous coronary artery stenting and early mortality in patients undergoing coronary artery
W Ghodbane1, W Ragmoun, R Arbi
1Service de chirurgie cardiothoracique, hôpital militaire de Tunis, 1008 Mont-Fleury, Tunis, Tunisie.
Insights
Patients who had prior percutaneous coronary intervention (PCI) before coronary artery bypass graft surgery (CABG) faced higher risks. This included increased perioperative bleeding, transfusions, and in-hospital mortality, indicating greater severity of coronary artery disease (CAD).
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Evaluating the impact of prior percutaneous coronary intervention (PCI) on adverse perioperative outcomes in patients undergoing coronary artery bypass graft surgery (CABG).
- Assessing the influence of previous interventional procedures on the safety and efficacy of subsequent major cardiac surgery.
Purpose of the Study:
- To determine if patients with a history of PCI experience a different rate of adverse perioperative outcomes compared to those undergoing primary CABG.
- To identify specific preoperative, intraoperative, and postoperative factors associated with prior PCI in CABG patients.
Main Methods:
- An observational study comparing outcomes of 240 CABG patients.
- Group A (n=35) had prior PCI before CABG; Group B (n=205) underwent primary CABG.
- Analysis included preoperative criteria, intraoperative data, and postoperative course, with logistic regression for mortality prediction.
Main Results:
- Patients with prior PCI exhibited higher rates of previous myocardial infarction, more complex coronary artery disease (CAD) distribution, and unstable angina.
- Intraoperative findings included a higher number of bypasses in the prior PCI group, with significantly increased 24-hour bleeding and blood product transfusion requirements.
- Prior PCI was identified as an independent predictor of increased postoperative in-hospital mortality (OR 2.24).
Conclusions:
- Patients referred for CABG with prior PCI present with more severe coronary artery disease.
- A significantly higher thirty-day mortality and morbidity rate was observed in patients with a history of prior PCI.
- Prior PCI is associated with increased perioperative complications and mortality in CABG patients.
Background:
In this study, we examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome in patients undergoing coronary artery bypass graft surgery (CABG).
Methods:
Outcomes of 240 CABG patients, collected consecutively in an observational study, were compared. Gp A (n=35) had prior PCI before CABG and Gp B (n=205) underwent primary CABG.
Results:
Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 48.6% vs 36.6% (P=0.003), distribution of CAD (P=0.0001), unstable angina: 45.7% vs 39% (P=0.04). For intraoperative data, the total number of established bypasses was 2.6 (GpA) vs 2.07 (Gp B) (P=0.017), with the number of arterial bypass grafts being: 20% vs 13% (P=ns). Regarding the postoperative course, no significant difference in troponine I rate, 24-hour bleeding: 962 ml (Gp A) vs 798 ml (Gp B) (P=0.004), transfusion (PRBC unit): 3.63 (Gp A) vs 2.5 (Gp B) (P=0.006). Previous PCI emerged as an independent predictor of postoperative in-hospital mortality (OR 2.24, 95% CI [1.52-2.75], P<0.01).
Conclusion:
Patients with prior PCI presented for CABG with more severe CAD. Thirty-day mortality and morbidity were significantly higher in patients with prior PCI.
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