Elsevier

Surgery

Volume 152, Issue 1, July 2012, Pages 5-11
Surgery

Original Communication
Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting

https://doi.org/10.1016/j.surg.2012.02.013Get rights and content

Background

We hypothesized that the incidence of previous percutaneous coronary intervention (PCI) is increasing and that prior PCI influences patient morbidity and mortality after coronary artery bypass grafting (CABG).

Methods

A total of 34,316 patients underwent isolated CABG operations at 16 different statewide, institutions from 2001 to 2008. Patients were stratified into prior PCI (n = 4346; 12.7%) and no prior PCI (n = 29,970). Patient risk factors, intraoperative variables, and outcomes were compared by univariate and multivariate analyses.

Results

The incidence of prior PCI in CABG has risen from <1% to 22.0% from 2001 to 2008 (P < .001). Prior PCI patients were younger (P < .001) and more commonly had previous myocardial infarction (P < .001), but less commonly had heart failure (P < .001). The operative mortality was similar between groups (2.3% vs 1.9%; P = .13). Prior PCI patients had more major complications (15.0% vs 12.0%; P < .001), longer hospitalization (P = .01), and higher readmission rates (P = .01). Importantly, by multivariate analyses, prior PCI was not associated with mortality, but was an independent predictor of major complications after CABG (odds ratio, 1.15; P = .01).

Conclusion

The incidence of prior PCI in patients undergoing CABG is increasing. Previous PCI is associated with a higher risk of major complications, greater hospital length of stay, and higher readmission rates after CABG.

Section snippets

Data collection

The Virginia Cardiac Surgery Quality Initiative (VCSQI) is a voluntary consortium of 16 different cardiac surgical centers and hospitals within the Commonwealth of Virginia that collectively captures approximately 99% of Virginia's cardiac operative procedures. Data analyses were exempt from the University of Virginia Institutional Review Board because the VCSQI database has no patient identifiers. In addition, participating institutions were exempt from Health Insurance Portability and

Incidence of PCI has increased over time

A total of 34,316 patients underwent isolated CABG surgeries from 2001 to 2008. Of those, 4346 (12.7%) patients had previous PCI. Prior to 2004, <1% of patients undergoing CABG had previous PCI. Since 2004, the incidence of prior PCI among CABG patients significantly increased (7.8% in 2004, 21.5% in 2005, 23.4% in 2006, 25.3% in 2007, and 22.0% in 2008; P < .001; Fig 1).

Preoperative and intraoperative risk factors

Patient demographics and preoperative risk factors are presented in Table I. Patients with prior PCI were comparatively

Discussion

Using a multicenter, retrospective analysis from 16 different statewide cardiac centers, we demonstrate that the incidence of PCI in patients undergoing CABG has risen since the introduction of DES in 2004. The objective of the study was to investigate the independent effect of prior PCI in patients undergoing CABG. Although there was no relationship between prior PCI and mortality after CABG, we determined that the risk-adjusted in-hospital major morbidity is worse in patients with prior PCI.

References (25)

  • E. Zupancich et al.

    Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: a randomized clinical trial

    J Thorac Cardiovasc Surg

    (2005)
  • Society of Thoracic Surgeons Adult Cardiac Surgery Database, STS Adult Cardiac Data Specifications....
  • Cited by (0)

    Supported by Award Number T32/HL007849 (DJL, CMB) from the National Heart, Lung, and Blood Institute and the Thoracic Surgery Foundation for Research and Education Research Grant (GA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.

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