Previous Percutaneous Coronary Interventions Increase Mortality and Morbidity After Coronary Surgery

• Published in: The Annals of thoracic surgery Vol. 93; no. 6; pp. 1956 - 1962
• Main Authors: Mannacio, Vito, MD, Di Tommaso, Luigi, MD, De Amicis, Vincenzo, MD, Lucchetti, Vincenzo, MD, Pepino, Paolo, MD, Musumeci, Francesco, MD, Vosa, Carlo, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2012; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angioplasty, Balloon, Coronary - mortality; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Cohort Studies; Comorbidity; Coronary Artery Bypass - mortality; Coronary Disease - mortality; Coronary heart disease; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heart; Hospital Mortality; Humans; Male; Medical sciences; Pneumology; Postoperative Complications - mortality; Postoperative Complications - surgery; Propensity Score; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Reoperation - mortality; Risk Factors; Stents; Surgery; Survival Rate; United States; United States; 23; Atherectomy; Prognosis; Angioplasty; Mortality; Coronary artery; Instrumentation therapy; Cardiovascular disease; Increase; Coronary heart disease; Stent; Morbidity; Percutaneous route; Surgery; Anesthesia; Circulatory system; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.02.067

Background This multicenter study investigated the impact of previous percutaneous coronary interventions (PCI) on postoperative outcome and 5-year survival of subsequent coronary artery bypass grafting. Methods Among 7,855 patients who underwent isolated first-time coronary artery bypass grafting between January 2000 and December 2005, 6,834 (87%) had no previous PCI and 1,021 (13%) had previous PCI with stenting. Logistic multiple regression and propensity score analyses were used to assess the risk-adjusted impact of prior PCI on in-hospital mortality and major adverse cardiac events. The Cox regression model was used to assess the effect of prior PCI on 3-year and 5-year survival. Results After risk-adjusted multivariate analysis, age over 70 years, female sex, 3-vessel or 2-vessel plus left main coronary disease, multivessel PCI, ejection fraction 0.40 or less, diabetes mellitus, previous myocardial infarction, and chronic obstructive pulmonary disease were identified as independent predictors of both hospital mortality and major adverse cardiac events. After propensity score matching, conditional logistic regression analysis identified history of previous PCI as significantly associated with an increased risk for hospital mortality (odds ratio, 2.8; 95% confidence interval 1.4 to 4.8; p = 0.003) and major adverse cardiac events (odds ratio 2.1; 95% confidence interval 1.2 to 3.6; p < 0.001). Survival at 3 and 5 years was lower in patients with previous PCI compared with the no-PCI patients (97.4% ± 0.01% vs 96.5% ± 0.02% and 94.2% ± 0.03% vs 92.1% ± 0.05%; log-rank test: p = 0.03). Conclusions Our results provided further evidence that history of PCI before coronary artery bypass grafting increases risk of both operative death and perioperative complications, and decreases survival at 5 years follow-up.