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Published on: March 27, 2018
Effect of Multiple Prior Percutaneous Coronary Interventions on Outcomes After Coronary Artery Bypass Grafting
Keisuke Hakamada1, Genichi Sakaguchi2, Akira Marui1
1Department of Cardiovascular Surgery, Kokura Memorial Hospital.
Insights
Multiple prior percutaneous coronary interventions (PCIs) before coronary artery bypass grafting (CABG) increase long-term death and cardiovascular risks. Repeat revascularization rates were similar across groups, regardless of prior PCI history.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The long-term impact of multiple prior percutaneous coronary interventions (PCIs) before coronary artery bypass grafting (CABG) remains unclear.
- Understanding these outcomes is crucial for guiding treatment strategies in patients with complex coronary artery disease.
Purpose of the Study:
- To evaluate the long-term effects of single versus multiple prior PCIs on outcomes following primary isolated CABG.
Main Methods:
- A retrospective analysis of 1,641 patients undergoing primary isolated CABG between 2007 and 2016.
- Patients were stratified into three groups: no prior PCI (Group N), single prior PCI (Group S), and multiple prior PCIs (Group M).
- Long-term outcomes, including all-cause death, cardiac death, myocardial infarction (MI), and repeat revascularization, were compared up to 10 years post-CABG.
Main Results:
- Patients with multiple prior PCIs (Group M) exhibited the highest cumulative incidences of all-cause death, cardiac death, and MI at 10 years.
- Adjusted analyses revealed a significantly higher risk of all-cause death (HR 1.45) and cardiac death/MI (HR 2.39 for cardiac death, HR 3.65 for MI) in Group M compared to Group N.
- No significant differences in all-cause death were observed between Group N and Group S. Repeat revascularization rates were similar across all groups.
Conclusions:
- Multiple prior PCIs are associated with increased long-term risks of mortality and major adverse cardiovascular events after CABG.
- The risk of repeat revascularization following CABG is low and not significantly influenced by the number of prior PCI procedures.
Background:
The effect of multiple prior percutaneous coronary interventions (PCIs) before subsequent coronary artery bypass grafting (CABG) on long-term outcomes has not been well elucidated.
Methods And Results:
Between 2007 and 2016, 1,154 patients undergoing primary isolated CABG in our institution had no prior PCI (Group N), 225 had a single prior PCI (Group S), and 272 had multiple prior PCIs (Group M). Cumulative incidences of all-cause death, cardiac death and myocardial infarction (MI) at 10 years post-CABG were highest in Group M. After adjusting for confounders, the risk of all-cause death was higher in Group M than in Group N (hazard ratio [HR] 1.45; 95% confidence interval [CI], 1.10-1.91; P<0.01). Between Groups N and S, however, the risk of all-cause death was not different. The risks of cardiac death and MI were likewise higher in Group M than in Group N (HR, 2.39; 95% CI, 1.55-3.71; P<0.01 and HR, 3.65; 95% CI, 1.16-11.5; P=0.03, respectively), but not different between Groups N and S. The risk of repeat revascularization was not different among any of the groups.
Conclusions:
Multiple prior PCIs was associated with higher risks of long-term death and cardiovascular events. The incidence of repeat revascularization after CABG was low regardless of the history of single/multiple PCIs.
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