The number of percutaneous coronary interventions is increasing with improving technology. There is limited outcome data on patients who had undergone a percutaneous coronary intervention and subsequently require surgical revascularization.
634 Patients underwent coronary artery bypass graft surgery (CABG) between 2001 and 2005. Mean follow-up was 29.4 ± 11.3 months and was complete in 611 patients. The effect of preoperative percutaneous coronary intervention as a risk factor for symptom recurrence and adverse cardiovascular events during follow up period was determined using multivariate Cox Regression Analysis.
There were no differences in the cardiovascular risk factors and intraoperative variables between patients in either group except for lower incidence of diabetes in percutaneous coronary intervention group. Preoperative percutaneous coronary intervention was an independent risk factor for symptom recurrence (p<0.0001), combined adverse cardiac events (p<0.0001) and slightly increased overall mortality (p 0.04) in the multivariate analysis. Comparison of patients with and without a prior percutaneous coronary intervention showed that former was significantly more prone to develop symptom recurrence, combined adverse cardiac events and overall mortality (Table 1). Among the patients with a history of percutaneous coronary intervention, the ones who developed restenosis following percutaneous coronary intervention had worse outcomes after CABG compared to the ones who did not (Table 2).
In this study, patients with previous percutaneous coronary intervention were more likely to develop symptom recurrence and adverse cardiovascular events following CABG. This difference was more pronounced in patients who had at least one recurrent stenosis after a percutaneous coronary intervention prior to CABG.
History of percutaneous coronary intervention and restenosis may act as an adverse prognostic factor following CABG.
Evaluation of Cardiovascular End Points According to PCI History.PCI (n=190)No PCI (n=421)pAngina22 (11.6%)12 (2.9%)0.0001CHF5 (2.6%)4 (1.0%)0.110MI9 (4.7%)4 (10.0%)0.003Reintervention23 (12.1%)9 (2.1%)0.0001CVA6 (3.2%)2 (0.5%)0.007Sudden Cardiac Death5 (2.6%)2 (0.5%)0.033Death19 (10.0%)15 (3.6%)0.0001
CVA: Cerebrovascular event, CHF: Congestive Heart Failure, MI: Myocardial InfarctionTable 2—
Evaluation of Individual End Points According to History of Failed PCI.Failed PCIPYes (n=69)No (n=121)Angina20 (29.0%)2 (1.7%)0.0001CHF5 (7.2%)00.003MI8 (11.6%)1 (0.8%)0.0001Reintervention21 (30.4%)2 (1.7%)0.0001CVA2 (2.9%)4 (3.3%)0.875 (7.2%)00.003Death18 (26.1%)1 (0.8%)0.0001
CHF: Congestive Heart Failure, CVA: Cerebrovascular accident, MI: Myocardial Infarction.
Ahmet Gurbuz, None.