Key result
A history of PCI prior to CABG was associated with a significantly increased risk of the primary cardiovascular endpoint compared to no prior PCI (HR 1.53; 95% CI 1.17-1.98; P=0.0016).
Why the study?
Does a history of previous PCI worsen cardiovascular outcomes in stable patients with LVEF ≥40% undergoing their first CABG?
Cohort (n=2,489)
Does a history of previous PCI worsen cardiovascular outcomes in stable patients with LVEF ≥40% undergoing their first CABG?
Hazard Ratio: 1.53 (95% CI 1.17–1.98)
p-value: p=0.0016
A history of PCI prior to CABG is associated with worse cardiovascular outcomes post-surgery in stable patients with preserved left ventricular function.
Prior PCI signals higher-risk CABG candidates; leaves open causality and need for prospective validation.
AIM: To determine the impact of previous coronary artery revascularization by percutaneous transluminal coronary angioplasty and/or stenting (PCI) on outcome after subsequent coronary artery bypass grafting (CABG). METHODS AND RESULTS: The ischaemia management with Accupril post-bypass Graft via Inhibition of the coNverting Enzyme (IMAGINE) trial, conducted between November 1999 and September 2004, tested whether early initiation of an angiotensin-converting enzyme inhibitor post-CABG, in stable patients with LVEF >or=40%, would reduce cardiovascular events. Of the 2489 patients included in the IMAGINE trial, undergoing their first operation, 430 had a history of PCI prior to surgery (PCI group), and 2059 were referred to surgery without previous PCI (non-PCI group). There was a significant increase in the primary IMAGINE endpoint in the PCI group, HR = 1.53 [1.17-1.98], P = 0.0016. Coronary revascularization, HR = 1.80 [1.13-2.87], P = 0.014, unstable angina requiring hospitalization, HR = 2.43 [1.52-3.89], P = 0.0002, were the two individual components that significantly increased in the PCI group, even when adjusted for baseline characteristics (age, sex, history of myocardial infarction or stroke, diabetes, treatment group, or off-pump surgery). CONCLUSION: Patients with left ventricular ejection fraction >or=40% having a history of PCI prior to surgery had a worse outcome post-CABG than those with no prior PCI. Further studies are needed to investigate whether these results apply for drug eluting stents.
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Chocron et al. (2008) conducted a cohort in Post-CABG (n=2,489). History of PCI prior to surgery vs. No previous PCI was evaluated on Primary IMAGINE endpoint (cardiovascular events) (HR 1.53, 95% CI 1.17-1.98, p=0.0016). A history of PCI prior to CABG was associated with a significantly increased risk of the primary cardiovascular endpoint compared to no prior PCI (HR 1.53; 95% CI 1.17-1.98; P=0.0016).
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