title: Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis.
abstract: OBJECTIVE
  Do prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis.
  
  
  METHODS
  Eight cardiac surgical centers provided outcome data of 37,140 consecutive patients who underwent isolated first-time coronary bypass grafting between January 2000 and December 2005. Twenty-two patient characteristics and outcome variables were retrieved. Three groups of patients were analysed for in-hospital mortality and in-hospital major adverse cardiac events: patients without a previous percutaneous coronary intervention, with 1 previous intervention, and with 2 or more previous percutaneous coronary interventions before bypass grafting. A total of 29,928 patients with complete information for prior percutaneous coronary intervention underwent final analysis. Unadjusted univariate and risk-adjusted multivariate logistic regression analysis as well as computed propensity score matching were performed, based on 14 major risk factors to correct for and minimize selection bias.
  
  
  RESULTS
  A total of 10.3% of patients had 1 previous percutaneous coronary intervention, and 3.7% of patients had 2 or more previous interventions. Risk-adjusted multivariate logistic regression analysis revealed a significant association of 2 or more previous percutaneous coronary interventions with in-hospital mortality (odds ratio [OR], 2.0; confidence interval [CI], 1.4-3.0; P = .0005) and major adverse cardiac events (OR, 1.5; CI, 1.2-1.9; P = .0013). After propensity score matching, conditional logistic regression analysis confirmed the results of adjusted analysis. A history of 2 or more previous percutaneous coronary interventions was significantly associated with in-hospital mortality (OR, 1.9; CI, 1.3-2.7; P = .0016) and major adverse cardiac events (OR, 1.5; CI, 1.2-1.9; P = .0019).
  
  
  CONCLUSIONS
  Multicenter analysis confirms that a history of multiple previous percutaneous coronary interventions increases in-hospital mortality and the incidence of major adverse cardiac events after subsequent coronary artery bypass grafting. Critical discussion of the treatment strategy in these patients is warranted.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen, Germany. parwis.massoudy@uk-essen.de
authors.forename: Parwis
authors.initials: P
authors.lastname: Massoudy
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.forename: Anja
authors.initials: A
authors.lastname: Marr
authors.forename: Georg
authors.initials: G
authors.lastname: Kleikamp
authors.forename: Ariane
authors.initials: A
authors.lastname: Maleszka
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Reiner
authors.initials: R
authors.lastname: Körfer
authors.forename: Miriam
authors.initials: M
authors.lastname: Radu
authors.forename: Arno
authors.initials: A
authors.lastname: Krian
authors.forename: Jens
authors.initials: J
authors.lastname: Litmathe
authors.forename: Emmeran
authors.initials: E
authors.lastname: Gams
authors.forename: Omer
authors.initials: O
authors.lastname: Sezer
authors.forename: Hans
authors.initials: H
authors.lastname: Scheld
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schiller
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.forename: Guido
authors.initials: G
authors.lastname: Dohmen
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Ingo
authors.initials: I
authors.lastname: Slottosch
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Markus
authors.initials: M
authors.lastname: Neuhäuser
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob