Key result
Multiple prior percutaneous coronary interventions before coronary artery bypass grafting were associated with a significantly higher risk of long-term all-cause death compared to no prior PCI (HR 1.45).
Why the study?
The effect of multiple prior percutaneous coronary interventions before subsequent coronary artery bypass grafting on long-term outcomes has not been well elucidated.
Does a history of multiple prior PCIs increase the risk of long-term death and cardiovascular events in patients undergoing subsequent CABG?
Cohort (n=1,651)
No
Does a history of multiple prior PCIs increase the risk of long-term death and cardiovascular events in patients undergoing subsequent CABG?
Hazard Ratio: 1.45 (95% CI 1.1–1.91)
Absolute Event Rate: 26.1% vs 16.9%
p-value: p=<0.01
Multiple prior PCIs, but not a single prior PCI, are associated with significantly higher long-term risks of all-cause death and cardiovascular events after subsequent CABG.
Multiple prior PCIs may identify higher-risk CABG patients; hypothesis-generating and should not yet change practice.
BACKGROUND: The effect of multiple prior percutaneous coronary interventions (PCIs) before subsequent coronary artery bypass grafting (CABG) on long-term outcomes has not been well elucidated. METHODS AND RESULTS: Between 2007 and 2016, 1,154 patients undergoing primary isolated CABG in our institution had no prior PCI (Group N), 225 had a single prior PCI (Group S), and 272 had multiple prior PCIs (Group M). Cumulative incidences of all-cause death, cardiac death and myocardial infarction (MI) at 10 years post-CABG were highest in Group M. After adjusting for confounders, the risk of all-cause death was higher in Group M than in Group N (hazard ratio [HR] 1.45; 95% confidence interval [CI], 1.10-1.91; P<0.01). Between Groups N and S, however, the risk of all-cause death was not different. The risks of cardiac death and MI were likewise higher in Group M than in Group N (HR, 2.39; 95% CI, 1.55-3.71; P<0.01 and HR, 3.65; 95% CI, 1.16-11.5; P=0.03, respectively), but not different between Groups N and S. The risk of repeat revascularization was not different among any of the groups. CONCLUSIONS: Multiple prior PCIs was associated with higher risks of long-term death and cardiovascular events. The incidence of repeat revascularization after CABG was low regardless of the history of single/multiple PCIs.
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Hakamada et al. (2020) conducted a cohort in Coronary artery disease (n=1,651). Multiple prior percutaneous coronary interventions vs. No prior percutaneous coronary intervention was evaluated on All-cause death (HR 1.45, 95% CI 1.10-1.91, p=<0.01). Multiple prior percutaneous coronary interventions before coronary artery bypass grafting were associated with a significantly higher risk of long-term all-cause death compared to no prior PCI (HR 1.45).
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