title: Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization: insights from the imagine study.
abstract: OBJECTIVE
  To determine the impact of previous coronary artery revascularization by percutaneous transluminal coronary angioplasty and/or stenting (PCI) on outcome after subsequent coronary artery bypass grafting (CABG).
  
  
  RESULTS
  The ischaemia management with Accupril post-bypass Graft via Inhibition of the coNverting Enzyme (IMAGINE) trial, conducted between November 1999 and September 2004, tested whether early initiation of an angiotensin-converting enzyme inhibitor post-CABG, in stable patients with LVEF >or=40%, would reduce cardiovascular events. Of the 2489 patients included in the IMAGINE trial, undergoing their first operation, 430 had a history of PCI prior to surgery (PCI group), and 2059 were referred to surgery without previous PCI (non-PCI group). There was a significant increase in the primary IMAGINE endpoint in the PCI group, HR = 1.53 [1.17-1.98], P = 0.0016. Coronary revascularization, HR = 1.80 [1.13-2.87], P = 0.014, unstable angina requiring hospitalization, HR = 2.43 [1.52-3.89], P = 0.0002, were the two individual components that significantly increased in the PCI group, even when adjusted for baseline characteristics (age, sex, history of myocardial infarction or stroke, diabetes, treatment group, or off-pump surgery).
  
  
  CONCLUSIONS
  Patients with left ventricular ejection fraction >or=40% having a history of PCI prior to surgery had a worse outcome post-CABG than those with no prior PCI. Further studies are needed to investigate whether these results apply for drug eluting stents.
authors.affiliation: Department of Cardiac Surgery, Hopital Jean Minjoz, University of Franche-Comté, 25030 Besançon Cedex, France. sidney.chocron@univ-fcomte.fr
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Jean Lucien
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Warnica
authors.forename: Pierre
authors.initials: P
authors.lastname: Block
authors.forename: David
authors.initials: D
authors.lastname: Johnstone
authors.forename: Martin G
authors.initials: MG
authors.lastname: Myers
authors.forename: Cristina Dana
authors.initials: CD
authors.lastname: Calciu
authors.forename: Anna
authors.initials: A
authors.lastname: Nozza
authors.forename: Pierre
authors.initials: P
authors.lastname: Martineau
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000628:therapy*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology*; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D015607:Stents / Q000009:adverse effects*; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome