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Published on: March 27, 2018
Anatomical burden of prior percutaneous coronary intervention and long-term outcomes after coronary artery bypass
Go Yamashita1, Jiro Sakai1, Takumi Takauchi1
1Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Insights
Prior multiple-lesion percutaneous coronary intervention (PCI) increases long-term risks of cardiac death, myocardial infarction, and repeat revascularization after coronary artery bypass grafting (CABG). Single-lesion PCI also elevated heart failure hospitalization risk.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Prior percutaneous coronary intervention (PCI) is common in patients undergoing coronary artery bypass grafting (CABG).
- The anatomical burden of prior PCI may influence long-term outcomes post-CABG.
- Understanding this impact is crucial for surgical decision-making and patient management.
Purpose of the Study:
- To investigate if the extent of prior PCI-treated lesions affects long-term outcomes after CABG.
- To differentiate the impact of prior PCI presence versus the anatomical burden of treated lesions.
Main Methods:
- Retrospective analysis of 1,205 patients undergoing isolated, non-emergent CABG (2000-2024).
- Patients categorized into no prior PCI, single-lesion PCI, or multiple-lesion PCI groups.
- Long-term outcomes (overall survival, cardiac death, MI, stroke, HF hospitalization, repeat revascularization) assessed via Kaplan-Meier and Cox models.
Main Results:
- Multiple-lesion PCI group showed higher in-hospital acute kidney injury rates.
- Overall survival was significantly lower in the multiple-lesion PCI group (15-year survival: 35.8% vs. 46.0% vs. 48.0%).
- Adjusted analysis revealed increased risks of cardiac death, myocardial infarction, and repeat revascularization in the multiple-lesion PCI group compared to no prior PCI.
Conclusions:
- Extensive prior PCI (multiple lesions) is linked to poorer long-term CABG outcomes.
- Single-lesion PCI increased heart failure hospitalization risk but had otherwise comparable outcomes to no prior PCI.
- Further multicenter studies are needed to validate these findings and address potential confounding factors.
Objectives:
This study aimed to determine whether the anatomical burden of prior percutaneous coronary intervention(PCI) influences long-term outcomes after coronary artery bypass grafting, beyond the impact of intervention presence alone.
Methods:
This retrospective study analyzed consecutive patients undergoing coronary artery bypass grafting at a single institution between 2000 and 2024. The inclusion criteria comprised isolated, non-emergent surgery. Patient categorization was based on prior PCI-treated lesions: none, single, or multiple. The primary endpoint was long-term overall survival. The secondary endpoints included cardiac death, myocardial infarction, stroke, heart failure hospitalization, and repeat revascularization. Long-term outcomes were assessed using Kaplan-Meier analysis and Cox multivariable models, adjusting for 26 clinical factors.
Results:
Of 2,442 patients, 1,205 met the inclusion criteria (755 none, 227 single-lesion, 223 multiple-lesion intervention). Over a median follow-up of 12.0 (interquartile range, 11.3-12.9; maximum: 24.2) years, the multiple-lesion intervention group had higher rates of in-hospital acute kidney injury (34.1% vs. 21.1% vs. 24.2%, P = 0.003). Overall survival differed significantly between groups over the follow-up period (log-rank P = 0.004), with 15-year survival rates of 35.8%, 46.0%, and 48.0% for multiple-lesion, single-lesion, and no prior PCI groups, respectively. After adjustment, multiple-lesion intervention was associated with increased risks of cardiac death (adjusted subdistribution hazard ratio: 1.91), myocardial infarction (2.26), and repeat revascularization (1.92) compared with no prior intervention.
Conclusions:
Multiple-lesion PCI was associated with higher long-term risks of cardiac death, myocardial infarction, and repeat revascularization, while stroke risk was similar. Single-lesion PCI showed outcomes comparable to no prior PCI except for higher heart failure hospitalization. These findings require confirmation in larger, multicenter comparative studies to address residual confounding.
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