Previous percutaneous coronary intervention as risk factor for coronary artery bypass grafting.
BACKGROUND
Percutaneous coronary intervention (PCI) has increased as the initial revascularization strategy in chronic coronary artery disease. Consequently, more patients undergoing coronary artery bypass grafting (CABG) have history of coronary stent.


OBJECTIVE
Evaluate the impact of previous PCI on in-hospital mortality after CABG in patients with multivessel coronary artery disease.


METHODS
Between May/2007 and June/2009, 1099 consecutive patients underwent CABG on cardiopulmonary bypass. Patients with no PCI (n=938, 85.3%) were compared with patients with previous PCI (n=161, 14.6%). Logistic regression models and propensity score matching analysis were used to assess the risk-adjusted impact of previous PCI on in-hospital mortality.


RESULTS
Both groups were similar, except for the fact that patients with previous PCI were more likely to have unstable angina (16.1% x 9.9%, P=0.019). In-hospital mortality after CABG was higher in patients with previous PCI (9.3% x 5.1%, P=0.034) and it was comparable with EuroSCORE and 2000 Bernstein-Parsonnet risk score. Using multivariate logistic regression analysis, previous PCI emerged as an independent predictor of postoperative in-hospital mortality (odds ratio 1.94, 95% CI 1.02-3.68, P=0.044) as strong as diabetes (odds ratio 1.86, 95% CI 1.07-3.24, P=0.028). After computed propensity score matching based on preoperative risk factors, in-hospital mortality remained higher among patients with previous PCI (odds ratio 3.46, 95% CI 1.10-10.93, P=0.034).


CONCLUSIONS
Previous PCI in patients with multivessel coronary artery disease is an independent risk factor for in-hospital mortality after CABG.This fact must be considered when PCI is indicated as initial alternative in patients with more severe coronary artery disease.
Instituto do Coração do Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil. lisboa@cardiol.br
Luiz Augusto Ferreira
LA
Lisboa
Omar Asdrúbal
OA
Mejia
Luís Alberto
LA
Dallan
Luiz Felipe
LF
Moreira
Luiz Boro
LB
Puig
Fabio Biscegli
FB
Jatene
Noedir Antonio
NA
Stolf
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D054855:Drug-Eluting Stents; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D016896:Treatment Outcome