Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery.
BACKGROUND
A possible relationship between increased perioperative risk during coronary artery bypass grafting (CABG) and previous percutaneous coronary intervention (PCI) is debatable. We sought to determine the impact of previous PCI on patient outcome after elective CABG.


RESULTS
Between January 2000 and January 2005, 2626 consecutive patients undergoing first-time isolated elective CABG as the primary revascularization procedure (group 1) were evaluated for in-hospital mortality and major adverse cardiac events (MACEs) and were compared with 360 patients after single PCI (group 2) and with 289 patients after multiple PCI sessions (group 3) before elective CABG. Unadjusted univariate and risk-adjusted multivariate logistic-regression analysis revealed previous multiple PCIs to be strongly associated with in-hospital mortality (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.52 to 3.21; P<0.001) and MACEs (OR, 2.28; 95% CI, 1.38 to 3.59; P<0.001). To control for selection bias, a computed propensity-score matching based on 13 patient characteristics and preoperative risk factors was performed separately comparing group 1 versus 2 and group 1 versus 3. After propensity matching, conditional logistic-regression analysis confirmed previous multiple PCIs to be strongly associated with in-hospital mortality (OR, 3.01; 95% CI, 1.51 to 5.98; P<0.0017) and MACEs (OR, 2.31; 95% CI, 1.45 to 3.67; P<0.0004).


CONCLUSIONS
In patients with a history of multiple PCI sessions, perioperative risk for in-hospital mortality and MACEs during subsequent elective CABG is increased.
Thielmann
Matthias
M
Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany. matthias.thielmann@uni-essen.de
Leyh
Rainer
R
Massoudy
Parwis
P
Neuhäuser
Markus
M
Aleksic
Ivan
I
Kamler
Markus
M
Herold
Ulf
U
Piotrowski
Jarowit
J
Jakob
Heinz
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000517:prevention & control / Q000601:surgery*; D023921:Coronary Stenosis / Q000188:drug therapy / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004343:Drug Implants; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D015607:Stents / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004343:Drug Implants