Mid-term outcomes of patients with PCI prior to CABG in comparison to patients with primary CABG.
The number of percutaneous coronary interventions (PCI) prior to coronary artery bypass grafting (CABG) increased drastically during the last decade. Patients are referred for CABG with more severe coronary pathology, which may influence postoperative outcome. Outcomes of 200 CABG patients, collected consecutively in an observational study, were compared (mean follow-up: 5 years). Group A (n = 100, mean age 63 years, 20 women) had prior PCI before CABG, and group B (n = 100, mean age 66, 20 women) underwent primary CABG. In group A, the mean number of administered stents was 2. Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 54 vs 34 (P = 0.007), distribution of CAD (P < 0.0001), unstable angina: 27 vs 5 (P < 0.0001). For intraoperative data, the total number of established bypasses was 2.43 +/- 1.08 vs 2.08 +/- 1.08 (P = 0.017), with the number of arterial bypass grafts being: 1.26 +/- 0.82 vs 1.07 +/- 0.54 (P = 0.006). Regarding the postoperative course, significant results could be demonstrated for: adrenaline dosage (0.83 vs 0.41 mg/h; [p is not significant (ns)]) administered in 67 group A vs 47 group B patients (P = 0.006), and noradrenaline dosage (0.82 vs 0.87 mg/h; ns) administered in 46 group A vs 63 group B patients (P = 0.023), CK/troponine I (P = 0.002; P < 0.001), postoperative resuscitation (6 vs 0; P = 0.029), intra aortic balloon pump 12 vs 1 (P = 0.003), and 30-day mortality (9% in group A vs 1% in group B; P = 0.018). Clopidogrel was administered in 35% of patients with prior PCI and in 19% of patients without prior PCI (P = 0.016). Patients with prior PCI presented for CABG with more severe CAD. Morbidity, mortality and reoperation rate during mid term were significantly higher in patients with prior PCI.
Eifert
Sandra
S
Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany. Sandra.Eifert@med. uni-muenchen.de
Mair
Helmut
H
Boulesteix
Anne-Laure
AL
Kilian
Eckehard
E
Adamczak
Martin
M
Reichart
Bruno
B
Lamm
Peter
P
D000368:Aged; D000789:Angina, Unstable / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000517:prevention & control; D009638:Norepinephrine / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011182:Postoperative Care; D018709:Statistics, Nonparametric; D015607:Stents / Q000706:statistics & numerical data; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D009638:Norepinephrine; D004837:Epinephrine