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Percutaneous Intervention Before Coronary Artery Bypass Surgery Does Not Unfavorably Impact Survival: A Single-Center
Suvitesh Luthra1, Miguel M Leiva Juárez2, Eshan Senanayake3
1Division of Cardiac Surgery, Derriford Hospital, Plymouth, United Kingdom.
Insights
Prior percutaneous coronary intervention (PCI) does not negatively impact survival rates for patients undergoing coronary artery bypass graft surgery (CABG). This study found similar short-term and improved long-term survival in patients with prior PCI.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Assessing the impact of prior percutaneous coronary intervention (PCI) on outcomes after coronary artery bypass graft surgery (CABG) is crucial for patient management.
- A significant number of patients undergoing CABG have a history of PCI, necessitating an understanding of its effects.
Purpose of the Study:
- To investigate the effect of prior PCI on short-term and long-term survival following CABG.
- To compare survival outcomes between patients with and without a history of PCI undergoing isolated first-time CABG.
Main Methods:
- Retrospective analysis of 4,634 patients undergoing isolated first-time CABG (April 2004 - March 2014).
- Propensity score matching created 1:1 risk-adjusted cohorts: 330 patients with prior PCI and 330 without.
- Kaplan-Meier survival analysis and Cox proportional hazards modeling were used to assess survival differences and predictors of mortality.
Main Results:
- In-hospital mortality was similar between groups (1.1% non-PCI vs. 0.9% prior PCI).
- Ten-year overall survival was higher in the prior PCI group (82.71%) compared to the non-PCI group (77.5%), though not statistically significant in initial analysis.
- Matched cohort analysis revealed significantly better survival at 5, 7, and 10 years for patients with prior PCI compared to those without.
Conclusions:
- Prior PCI is not associated with adverse short-term or long-term survival outcomes after CABG.
- The findings suggest that a history of PCI does not negatively impact survival following coronary artery bypass surgery.
Background:
This retrospective propensity-matched study investigated the impact of prior percutaneous coronary intervention (PCI) on short-term and long-term survival after coronary artery bypass graft surgery (CABG).
Methods:
A total of 4,634 patients underwent isolated first-time CABG between April 2004 and March 2014. Among these, 424 (9.2%) had PCI. Propensity score analysis yielded 1:1 risk-adjusted matched groups: PCI (330 patients) and non-PCI (330 patients). A Cox proportional hazards model was used among the matched groups to assess the impact of prior PCI among other variables. Kaplan-Meier survival curves were compared at 1, 2, 3, 5, 7, and 10 years using the log-rank test to assess differences in survival.
Results:
In-hospital 30-day mortality was 1.1% (non-PCI) versus 0.9% (prior PCI; p = 0.66). Overall survival at 10 years was 77.5% (non-PCI) versus 82.71% (prior PCI; p = 0.4). Cox regression analysis identified European System for Cardiac Operative Risk Evaluation, nonsinus rhythm, age, pulmonary disease, and urgent surgery as risk factors for increased mortality. Prior PCI was not an independent predictor for mortality (hazard ratio, 0.55; 95% confidence interval, 0.25 to 1.18; p = 0.123). Overall survival in matched cohorts, non-PCI versus prior PCI, was 96.02% versus 97.13% (p = 0.08) at 1 year, 92.64% versus 96.36% (p = 0.08) at 3 years, 90.01% versus 93.47% (p = 0.02) at 5 years, 83.33% versus 90.37% (p = 0.01) at 7 years, and 73.56% versus 90.27% (p = 0.004) at 10 years.
Conclusions:
The survival in matched cohorts did not show adverse outcomes with prior PCI at 1, 3, 5, 7, and 10 years. Prior PCI does not adversely impact survival after CABG.
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