Key result
Among patients undergoing coronary artery bypass grafting, a history of multiple prior percutaneous coronary interventions significantly increased the risk of 5-year myocardial infarction (SHR 2.566) and repeat revascularization compared to no prior PCI.
Why the study?
The study evaluated the risk of late mortality and major adverse cardiovascular and cerebral events after CABG in patients with prior PCI.
Does prior PCI increase the risk of late mortality and major adverse cardiovascular and cerebral events in patients undergoing CABG?
Cohort (n=2,619)
Yes
Does prior PCI increase the risk of late mortality and major adverse cardiovascular and cerebral events in patients undergoing CABG?
Hazard Ratio: 2.566 (95% CI 1.379–4.312)
Absolute Event Rate: 10.9% vs 3.2%
Multiple prior PCIs before CABG are associated with an increased risk of late myocardial infarction and repeat revascularization, but do not negatively impact 5-year mortality.
Multiple prior PCIs were associated with increased late MI and revascularization after CABG; leaves open whether this informs preoperative risk assessment.
OBJECTIVES: The aim of the present study was to evaluate the risk of late mortality and major adverse cardiovascular and cerebral events after coronary artery bypass grafting (CABG) in patients with prior percutaneous coronary intervention (PCI). METHODS: A total of 2948 patients undergoing isolated CABGs were included in a prospective multicenter registry. Outcomes were adjusted for multiple covariates in logistic regression, Cox proportional hazards analysis and competing risk analysis. RESULTS: In all, 2619 patients fulfilled the inclusion criteria of this analysis. Of them, 2199 (79.1%) had no history of PCI and 420 (20.9%) had a prior PCI. An adjusted analysis showed that a single prior PCI and multiple prior PCIs did not increase the risk of 30-day and 5-year mortality. Patients with multiple prior PCIs had a significantly higher risk of 5-year myocardial infarction (SHR 2.566, 95%CI 1.379-4.312) and repeat revascularization (SHR 1.774, 95%CI 1.140-2.763). Similarly, 30-day and 5-year mortality were not significantly increased in patients with prior PCI treatment of single or multiple vessels. Patients with multiple vessels treated with PCI had a significantly higher risk of 5-year myocardial infarction (SHR 2.640, 95%CI 1.497-4.658), repeat revascularization (SHR 1.648, 95%CI 1.029-2.638) and stroke (SHR 2.215, 95%CI 1.056-4.646) at 5-year. The risk for repeat revascularization was also increased with a prior single vessel PCI, but not for other outcomes. CONCLUSIONS: Among patients undergoing CABGs, multiple prior PCIs seem to increase the risk of late myocardial infarction and the need for repeat revascularization, but not the risk of mortality.
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Biancari et al. (2022) conducted a cohort in Coronary artery disease requiring coronary artery bypass grafting (n=2,619). Multiple prior percutaneous coronary interventions (≥2 prior PCIs) vs. No prior PCI was evaluated on 5-year myocardial infarction (SHR 2.566, 95% CI 1.379-4.312). Among patients undergoing coronary artery bypass grafting, a history of multiple prior percutaneous coronary interventions significantly increased the risk of 5-year myocardial infarction (SHR 2.566) and repeat revascularization compared to no prior PCI.
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