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(Circulation. 2005;112:I-351 – I-357.)
© 2005 American Heart Association, Inc.

Surgery for Coronary Artery Disease

The Impact of Preoperative Thrombolysis on Long-Term Survival After Coronary Artery Bypass Grafting

Ioannis K. Toumpoulis, MD; Constantine E. Anagnostopoulos, MD; Demosthenes G. Katritsis, MD, PhD; Joseph J. DeRose, Jr, MD; Daniel G. Swistel, MD

From the Department of Cardiac Surgery (I.K.T., C.E.A, J.J.D, D.G.S.), College of Physicians and Surgeons of Columbia University, St Luke’s–Roosevelt Hospital Center, New York, NY; the Department of Cardiac Surgery (I.K.T., C.E.A.), University of Athens School of Medicine, Attikon Hospital Center, Athens, Greece; and the Department of Cardiology (D.G.K.), Athens Euroclinic, Athens, Greece.

Correspondence to Dr Constantine E. Anagnostopoulos, St. Luke’s–Roosevelt Hospital Center at Columbia University, 45 E 89th St, New York, NY 10128. E-mail cea8{at}columbia.edu

Background— Coronary artery bypass grafting (CABG) is frequently used after thrombolytic therapy. However, there is little information regarding long-term survival in this setting. The purpose of the present study was to compare the long-term survival of patients subjected to CABG after thrombolysis to those without thrombolysis.

Methods and Results— We studied 3760 consecutive patients with isolated CABG between 1992 and 2002. CABG patients without thrombolysis were compared with those who were treated with thrombolysis within 7 days before CABG. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for thrombolysis was determined by logistic regression analysis, and each patient with thrombolysis was then matched to 5 patients without thrombolysis. One hundred ninety-six patients (5.2%) were treated with thrombolysis. Patients with thrombolysis were more likely to be male, younger, and with higher rates of unstable angina, emergency operation, recent or transmural myocardial infarction, preoperative intraaortic balloon pump, hemodynamic instability, shock, intravenous nitroglycerine, left-ventricular hypertrophy, sustained ventricular arrhythmia, and higher EuroSCORE. There were no differences in early outcome between matched groups, but the 5-year actuarial survival was higher in patients with thrombolysis (90.3±2.2% versus 78.5±1.6%; P=0.0007). After adjustment for all factors, the hazard ratio of long-term mortality for patients with thrombolysis was 0.54 (95% CI, 0.36 to 0.81; P=0.003) and, if deaths during the first 12 months were excluded, 0.46 (95% CI, 0.27 to 0.76; P=0.003).

Conclusions— Patients subjected to CABG within 7 days after thrombolysis demonstrated increased long-term survival.

Key Words: thrombolysis • coronary artery bypass grafting • long-term mortality