University of Oulu

Biancari, F., Dalén, M., Ruggieri, V., Demal, T., Gatti, G., Onorati, F., Faggian, G., Rubino, A., Maselli, D., Gherli, R., Salsano, A., Saccocci, M., Santarpino, G., Nicolini, F., Tauriainen, T., De Feo, M., Airaksinen, J., Rosato, S., Perrotti, A., Mariscalco, G. (2018) Prognostic Impact of Multiple Prior Percutaneous Coronary Interventions in Patients Undergoing Coronary Artery Bypass Grafting. Journal of the American Heart Association, 7 (20), e010089. doi:10.1161/JAHA.118.010089

Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting

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Author: Biancari, Fausto1,2; Dalén, Magnus3; Ruggieri , Vito G.4;
Organizations: 1Department of Surgery, Oulu University Hospital and University of Oulu
2Heart Center, Turku University Hospital and University of Turku
3Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital
4Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital
5Hamburg University Heart Center
6Division of Cardiac Surgery, Ospedali Riuniti
7Division of Cardiovascular Surgery, Verona University Hospital
8Centro Clinico-Diagnostico “G.B. Morgagni,” Centro Cuore
9Department of Cardiac Surgery, St. Anna Hospital
10Cardiac Surgery Unit, Department of Cardiovascular Sciences, S. Camillo-Forlanini Hospital
11Division of Cardiac Surgery, University of Genoa
12Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, University of Milan
13Cardiovascular Center, Paracelsus Medical University
14Città di Lecce Hospital GVM Care & Research
15Division of Cardiac Surgery, University of Parma
16Department of Cardiothoracic and Respiratory Sciences, University of Campania
17National Center of Global Health, Istituto Superiore di Sanità
18Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz
19Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield Hospital, University of Leicester
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: John Wiley & Sons, 2018
Publish Date: 2019-01-15


Background: Multiple percutaneous coronary interventions (PCIs) are considered determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but scarce data exist to substantiate this.

Methods and results: Patients who underwent CABG without history of prior PCI or with PCI performed >30 days before surgery were selected for the present analysis from the prospective, multicenter E‐CABG (European Multicenter Study on Coronary Artery Bypass Grafting) registry. Out of 6563 patients with data on preoperative SYNTAX (Synergy between PCI With Taxus and Cardiac Surgery) score, 1181 patients (18.0%) had undergone PCI >30 days before CABG. Of these, 11.6% underwent a single PCI, 4.4% 2 PCIs, and 2.1% ≥3 PCIs. PCI of a single main coronary vessel was performed in 11.3%, of 2 main vessels in 4.9%, and of 3 main vessels in 1.6% of patients. Multivariable analysis showed that differences in early mortality and other outcomes were not significantly different in the study cohorts. The adjusted hospital/30‐day mortality rate was 1.8% in patients without history of prior PCI, 1.9% in those with a history of 1 PCI, 1.4% after 2 PCIs, and 2.5% after ≥3 PCIs (adjusted P=0.8). The adjusted hospital/30‐day mortality rate was 2.0% in those who had undergone PCI of 1 main coronary vessel, 1.3% after PCI of 2 main vessels, and 3.1% after PCI of 3 main coronary vessels (adjusted P=0.6).

Conclusions: Multiple prior PCIs are not associated with increased risk of early adverse events in patients undergoing isolated CABG. The present results are conditional to survival after PCI and should not be viewed as a support for a policy of multiple PCI as opposed to earlier CABG.

Clinical trial registration: URL: Unique identifier: NCT02319083. ( J Am Heart Assoc. 2018;7: e010089. DOI: 10.1161/JAHA.118.010089.)

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Series: Journal of the American Heart Association
ISSN: 2047-9980
ISSN-E: 2047-9980
ISSN-L: 2047-9980
Volume: 7
Issue: 20
Article number: e010089
DOI: 10.1161/JAHA.118.010089
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.