The impact of preoperative thrombolysis on long-term survival after coronary artery bypass grafting.
BACKGROUND
Coronary artery bypass grafting (CABG) is frequently used after thrombolytic therapy. However, there is little information regarding long-term survival in this setting. The purpose of the present study was to compare the long-term survival of patients subjected to CABG after thrombolysis to those without thrombolysis.


RESULTS
We studied 3760 consecutive patients with isolated CABG between 1992 and 2002. CABG patients without thrombolysis were compared with those who were treated with thrombolysis within 7 days before CABG. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for thrombolysis was determined by logistic regression analysis, and each patient with thrombolysis was then matched to 5 patients without thrombolysis. One hundred ninety-six patients (5.2%) were treated with thrombolysis. Patients with thrombolysis were more likely to be male, younger, and with higher rates of unstable angina, emergency operation, recent or transmural myocardial infarction, preoperative intraaortic balloon pump, hemodynamic instability, shock, intravenous nitroglycerine, left-ventricular hypertrophy, sustained ventricular arrhythmia, and higher EuroSCORE. There were no differences in early outcome between matched groups, but the 5-year actuarial survival was higher in patients with thrombolysis (90.3+/-2.2% versus 78.5+/-1.6%; P=0.0007). After adjustment for all factors, the hazard ratio of long-term mortality for patients with thrombolysis was 0.54 (95% CI, 0.36 to 0.81; P=0.003) and, if deaths during the first 12 months were excluded, 0.46 (95% CI, 0.27 to 0.76; P=0.003).


CONCLUSIONS
Patients subjected to CABG within 7 days after thrombolysis demonstrated increased long-term survival.
Toumpoulis
Ioannis K
IK
Department of Cardiac Surgery, College of Physicians and Surgeons of Columbia University, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
Anagnostopoulos
Constantine E
CE
Katritsis
Demosthenes G
DG
DeRose
Joseph J
JJ
Swistel
Daniel G
DG
D000368:Aged; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D015993:Life Tables; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000601:surgery; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome