Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting
Biancari, Fausto; Dalén, Magnus; Ruggieri , Vito G.; Demal, Till; Gatti , Giuseppe; Onorati, Francesco; Faggian, Giuseppe; Rubino, Antonino S.; Maselli , Daniele; Gherli, Riccardo; Salsano, Antonio; Saccocci, Matteo; Santarpino, Giuseppe; Nicolini, Francesco; Tauriainen, Tuomas; De Feo, Marisa; Airaksinen, Juhani; Rosato, Stefano; Perrotti, Andrea; Mariscalco, Giovanni (2018-10-16)
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
© 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.
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe201901152131
Tiivistelmä
Abstract
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: http://www.Clinicaltrials.gov. Unique identifier: NCT02319083. ( J Am Heart Assoc. 2018;7:e010089. DOI: 10.1161/JAHA.118.010089.)
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