Key result
Previous repeated percutaneous coronary intervention was identified as an independent risk factor for cardiac death after subsequent coronary artery bypass grafting (HR 1.189 per PCI).
Why the study?
Does a history of repeated percutaneous coronary intervention increase the risk of adverse long-term outcomes in patients undergoing subsequent coronary artery bypass grafting?
Cohort (n=894)
No
Does a history of repeated percutaneous coronary intervention increase the risk of adverse long-term outcomes in patients undergoing subsequent coronary artery bypass grafting?
Hazard Ratio: 1.189 (95% CI 1.061–1.332)
p-value: p=0.0029
A history of repeated percutaneous coronary intervention prior to coronary artery bypass grafting is associated with worse long-term survival and an increased risk of cardiac events.
Repeated prior PCI associated with higher post-CABG cardiac mortality; leaves open optimal initial revascularization strategy.
BACKGROUND: In the current stent era, aggressive repeated percutaneous coronary intervention (PCI) has become more common. The aim of this study was to investigate the impact of previous repeated PCI on the subsequent coronary artery bypass grafting (CABG). METHODS: Between January 1990 and January 2008, a total of 894 patients underwent first-time isolated elective CABG. Among the 894 patients, 515 patients had had no PCI (group A), 179 patients had had single PCI (Group B), and 200 patients had had multiple PCI (2-15 times, mean 3.6 ± 2.3 times) (group C) before CABG. These groups were compared in terms of early and late clinical results. RESULTS: Preoperative left ventricular ejection fraction was significantly higher in group A (group A;58 ± 13%, group B;54 ± 12%, and group C;54 ± 12%). Number of bypass grafts was significantly smaller in group C (A:3.3 ± 1.0, B 3.4 ± 0.9, C 3.1 ± 1.0). Although there was no statistically significant difference among the groups, in-hospital mortality in group C was higher than that in group A and B (A:1.6%, B:1.1%, C:3.5%, p = 0.16). Survival analysis by Kaplan-Meier method (mean follow-up: 58 ± 43 methods) revealed that freedom from all-cause death and cardiac death was significantly lower in group C in comparison with group A. Freedom from cardiac event was significantly higher in group C than that in group A. Multivariate analysis identified a number of previous PCI as an independent risk factor for cardiac death. CONCLUSIONS: Repeated PCI increased risk for long-term prognosis of subsequent CABG.
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Sakaguchi et al. (2011) conducted a cohort in Coronary artery disease requiring CABG (n=894). Previous repeated percutaneous coronary intervention (PCI) vs. No previous PCI was evaluated on Cardiac death (HR 1.189, 95% CI 1.061-1.332, p=0.0029). Previous repeated percutaneous coronary intervention was identified as an independent risk factor for cardiac death after subsequent coronary artery bypass grafting (HR 1.189 per PCI).
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