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Does Prior Percutaneous Coronary Revascularization Negatively Affect the Outcomes of Subsequent Coronary Artery
Vittoria Lodo1, Cecilia Capozza2, Cristina Barbero3
1Department of Cardiac Surgery, Mauriziano Hospital, Turin, Italy.
Insights
Prior percutaneous coronary intervention (PCI) does not increase early or midterm mortality after coronary artery bypass grafting (CABG). However, multiple prior PCI procedures are linked to increased perioperative myocardial infarction and adverse events during follow-up.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Increasing use of percutaneous coronary intervention (PCI) leads to more patients needing coronary artery bypass grafting (CABG) post-PCI.
- The impact of prior PCI on CABG outcomes and the significance of PCI burden are not fully understood.
Purpose of the Study:
- To evaluate the effect of prior PCI on outcomes following CABG.
Main Methods:
- Analysis of 2,823 patients undergoing elective isolated CABG across six centers (2018-2022).
- Patients stratified into no prior PCI, single prior PCI, or multiple prior PCI groups.
- Assessment of early postoperative outcomes and 1- and 3-year follow-up events, with midterm all-cause mortality as the primary endpoint.
Main Results:
- Early mortality was similar across groups; however, multiple prior PCI was associated with higher perioperative myocardial infarction (2.9% vs. 0.9% vs. 0.6%, p=0.015).
- During follow-up, prior PCI, especially multiple procedures, correlated with increased rates of myocardial infarction, stroke, and repeat revascularization.
- Midterm survival rates were similar among all groups.
Conclusions:
- Prior PCI does not elevate early or midterm mortality after elective isolated CABG.
- Multiple prior PCI procedures are linked to increased perioperative myocardial infarction and adverse cardiovascular events post-CABG.
- PCI burden should be incorporated into preoperative risk stratification and Heart Team decision-making for CABG patients.
Background:
The growing use of percutaneous coronary intervention (PCI) has led to an increasing number of patients referred for coronary artery bypass grafting (CABG) after prior PCI. The impact of previous PCI on CABG outcomes remains controversial, and the prognostic significance of PCI burden has not been fully clarified. This study evaluated the effect of prior PCI on outcomes after CABG.
Methods:
Consecutive patients undergoing elective isolated CABG at 6 high-volume centers between 2018 and 2022 were analyzed. Patients were stratified according to PCI history into no prior PCI, single prior PCI, or multiple prior PCIs. Early postoperative outcomes and 1- and 3-year follow-up events were assessed. The primary end point was midterm all-cause mortality.
Results:
A total of 2823 patients were included. Baseline characteristics were comparable among groups. Patients with multiple prior PCIs more frequently required coronary endarterectomy and grafting of small-caliber target vessels. Early mortality was similar across groups, whereas perioperative myocardial infarction was more frequent in patients with multiple prior PCIs (2.9% vs 0.9% vs 0.6%; P = .015). During follow-up, prior PCI, particularly multiple procedures, was associated with higher rates of myocardial infarction, stroke, and repeat revascularization, whereas midterm survival was similar.
Conclusions:
Prior PCI was not associated with increased early or midterm mortality after elective isolated CABG. However, multiple prior PCIs were associated with higher perioperative myocardial infarction and adverse cardiovascular events during follow-up, a finding suggesting that PCI burden should be considered in preoperative risk stratification and heart team decision making.
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