Does prior percutaneous coronary intervention adversely affect early and mid-term survival after coronary artery surgery?
OBJECTIVE
To determine the association between previous percutaneous coronary intervention (PCI) and results after coronary artery bypass graft surgery (CABG).


BACKGROUND
Increasing numbers of patients undergoing CABG have previously undergone PCI.


METHODS
We analyzed consecutive first-time isolated CABG procedures within the Australasian Society of Cardiac and Thoracic Surgeons Database from June 2001 to May 2008. Logistic regression and propensity score analyses were used to assess the risk-adjusted impact of prior PCI on in-hospital mortality and major adverse cardiac events. Cox regression model was used to assess the effect of prior PCI on mid-term survival.


RESULTS
Of 13,184 patients who underwent CABG, 11,727 had no prior PCI and 1,457 had prior PCI. Mean follow-up was 3.3 +/- 2.1 years. Patients without prior PCI had a higher EuroSCORE value (4.4 +/- 3.3 vs. 3.6 +/- 3.0, p < 0.001), were older, and more likely to have left main stem stenosis and recent myocardial infarction. There was no difference in unadjusted in-hospital mortality (1.65% vs. 1.55%, p = 0.78) or major adverse cardiac events (3.0% vs. 3.0%, p = 0.99) between patients with or without prior PCI. After adjustment, prior PCI was not a predictor of in-hospital (odds ratio: 1.22, 95% confidence interval [CI]: 0.76 to 2.0, p = 0.41) or mid-term mortality at 6-year follow-up (hazard ratio: 0.94, 95% CI: 0.75 to 1.18, p = 0.62).


CONCLUSIONS
In this large registry study, prior PCI was not associated with increased short- or mid-term mortality after CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI.
Yap
Cheng-Hon
CH
Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia. chenghonyap@hotmail.com
Yan
Bryan P
BP
Akowuah
Enoch
E
Dinh
Diem T
DT
Smith
Julian A
JA
Shardey
Gilbert C
GC
Tatoulis
James
J
Skillington
Peter D
PD
Newcomb
Andrew
A
Mohajeri
Morteza
M
Pick
Adrian
A
Seevanayagam
Siven
S
Reid
Christopher M
CM
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure