The impact of prior percutaneous coronary intervention on long-term survival after coronary artery bypass grafting
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Wesley T O'Neal1, Jimmy T Efird, Curtis A Anderson
1Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States.
Insights
Prior percutaneous coronary intervention (PCI) does not significantly impact long-term survival after coronary artery bypass grafting (CABG). This study found similar survival rates between patients with and without prior PCI, offering clarity for postoperative care planning.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Outcomes Research
Background:
- Conflicting evidence exists regarding the impact of prior percutaneous coronary intervention (PCI) on long-term survival following coronary artery bypass grafting (CABG).
- Understanding this relationship is crucial for optimizing patient care strategies.
Purpose of the Study:
- To investigate the influence of prior PCI on long-term survival in patients undergoing CABG.
- To provide robust data from a large tertiary referral heart institute.
Main Methods:
- A retrospective analysis compared long-term survival (1992-2011) in non-emergent CABG patients with and without prior PCI.
- Cox regression modeling was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).
Main Results:
- Of 13,354 CABG patients, 2,532 (19%) had undergone prior PCI.
- Median survival was 15 years for patients with prior PCI versus 14 years for those without (p<0.0001).
- After adjusting for multiple clinical factors, prior PCI was not a significant predictor of long-term survival (adjusted HR=0.99, 95%CI=0.91-1.06).
Conclusions:
- Prior PCI is not a significant predictor of long-term survival after CABG.
- These findings support evidence-based planning for postoperative patient care.
- Outcomes research is vital for refining clinical decision-making in cardiac surgery.
Background:
Previous studies examining the influence of prior percutaneous coronary intervention (PCI) on long-term survival after coronary artery bypass grafting (CABG) have reported conflicting results. The purpose of this study was to further examine the influence of prior PCI on long-term survival after CABG at a large tertiary referral heart institute.
Methods:
Long-term survival between 1992 and 2011 was compared in non-emergent CABG cases with and without prior PCI. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model.
Results:
A total of 2532 (19%) patients had prior PCI before CABG (n=13,354). The median follow-up for study participants was 8.1 years. The median survival for patients with and without prior PCI was 15 years and 14 years, respectively (p<0.0001). Long-term survival was similar between patients with and without prior PCI after adjusting for age, sex, race, hypertension, coronary artery disease severity, congestive heart failure, and prior stroke (adjusted HR=0.99, 95%CI=0.91-1.06).
Conclusion:
Findings from outcomes research are important in the planning of appropriate postoperative patient care. Our study provides additional evidence that prior PCI is not a significant predictor of long-term survival after CABG.
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