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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
[Outcome analysis of patients undergoing percutaneous coronary intervention with or without prior coronary artery
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Previous coronary artery bypass grafting (CABG) does not independently predict poor outcomes for patients undergoing percutaneous coronary intervention (PCI). Propensity score matching confirmed CABG is not a risk factor for cardiac mortality or revascularization after PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary heart disease.
- Percutaneous coronary intervention (PCI) is an alternative revascularization strategy.
- The long-term impact of prior CABG on PCI outcomes requires clarification.
Purpose of the Study:
- To evaluate the association between a history of CABG and long-term adverse cardiovascular events in patients undergoing PCI.
- To determine if previous CABG is an independent risk factor for poor prognosis after PCI.
Main Methods:
- Prospective study of 10,724 coronary heart disease patients undergoing PCI.
- Patients divided into groups with (n=437) and without (n=10,287) prior CABG.
- 2-year follow-up for major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, revascularization, stroke, and in-stent thrombosis.
- Multivariate Cox regression and propensity score matching analyses were employed.
Main Results:
- Patients with prior CABG were older and had more comorbidities, including diabetes and hyperlipidemia.
- Unadjusted analysis showed higher rates of cardiac death and revascularization in the CABG group.
- Multivariate Cox regression identified prior CABG as an independent risk factor for cardiac death and revascularization.
- After propensity score matching, prior CABG was no longer an independent risk factor for cardiac mortality or revascularization.
Conclusions:
- Previous CABG is not an independent risk factor for poor prognosis in patients undergoing PCI.
- Initial unadjusted findings may be confounded by patient characteristics.
- Propensity score matching provides a more accurate assessment of CABG's independent impact on PCI outcomes.
Abstract:
Objective: To investigate the impact of previous coronary artery bypass grafting(CABG) on long-term outcomes in patients undergoing percutaneous coronary intervention(PCI). Methods: A total of 10 724 consecutive coronary heart disease patients undergoing PCI between January and December 2013 in Fuwai hospital were prospectively included in this research. According to CABG history, the patients were divided into CABG group(437 cases) and without CABG group(10 287 cases). The patients were followed up for 2 years. Major adverse cardiovascular and cerebrovascular events(MACCE) including death, myocardial infarction, revascularization and stroke, and in-stent thrombosis following PCI were compared between the 2 groups. Multivariate Cox regression analysis was used to identify independent risk factors of poor prognosis. Results: Compared with without CABG group, CABG group were older((61±10)years vs.(58±10)years, P<0.001), and more often had diabetes(35.7%(156/437) vs. 30.0%(3 082/10 287), P=0.012), hyperlipoidemia(73.9%(323/437) vs. 67.0%(6 888/10 287), P=0.003), previous myocardial infarction(31.1%(136/437) vs. 18.7%(1 925/10 287), P<0.001), PCI history(61.6%(269/437) vs. 23.0%(2 371/10 287), P<0.001), and cerebrovascular disease(7.1%(31/437) vs. 10.9%(1 119/10 287), P=0.013). After 2 years follow-up, rates of cardiac death(1.8%(8/437) vs. 0.6%(66/10 287), P=0.010), revascularization(11.2%(49/437) vs. 8.5%(877/10 287), P=0.049) and MACCE(15.1%(66/437) vs. 12.0%(1 231/10 287), P=0.049) were significantly higher in CABG patients than in without CABG group. There were no significant difference in all cause death(2.1%(9/437) vs. 1.2%(122/10 287), P=0.114), recurrence of myocardial infarction(2.3%(10/437) vs. 2.0%(204/10 287), P=0.600), stroke(1.1%(5/437) vs. 1.4%(140/10 287), P=0.701), and in-stent thrombosis(1.1%(5/437) vs. 0.6%(61/10 287), P=0.194). Multivariate Cox regression analysis showed that previous CABG was an independent risk factor of cardiac death(HR=2.13, 95%CI 1.02-4.46, P=0.045)and revascularization(HR=1.35, 95%CI 1.01-1.81, P=0.040). However, after propensity score matched analyses(429 pairs), previous CABG was no longer an independent risk factor of cardiac mortality (HR=0.97, 95% CI 0.37-2.54, P=0.954)and revascularization(HR=1.74, 95%CI 0.94-3.21, P=0.753). Conclusion: Previous CABG is not an independent risk factor of poor prognosis in coronary heart disease patients undergoing PCI.
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