This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thielmann, M. Articles by Jakob, H. Search for Related Content PubMed PubMed Citation Articles by Thielmann, M. Articles by Jakob, H. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Coronary Artery Bypass Surgery Related Collections CV surgery: coronary artery disease

(Circulation. 2006;114:I-441 – I-447.)
© 2006 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Prognostic Significance of Multiple Previous Percutaneous Coronary Interventions in Patients Undergoing Elective Coronary Artery Bypass Surgery

Matthias Thielmann, MD; Rainer Leyh, MD; Parwis Massoudy, MD; Markus Neuhäuser, PhD; Ivan Aleksic, MD; Markus Kamler, MD; Ulf Herold, MD; Jarowit Piotrowski, MD; Heinz Jakob, MD

From the Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen (M.T., R.L., P.M., I.A., M.K., U.H., J.P., H.J.) and the Institute for Medical Informatics, Biometry, and Epidemiology (M.N.), University Hospital Essen, Essen, Germany.

Correspondence to Matthias Thielmann, MD, Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany. E-mail matthias.thielmann{at}uni-essen.de

Background— A possible relationship between increased perioperative risk during coronary artery bypass grafting (CABG) and previous percutaneous coronary intervention (PCI) is debatable. We sought to determine the impact of previous PCI on patient outcome after elective CABG.

Methods and Results— Between January 2000 and January 2005, 2626 consecutive patients undergoing first-time isolated elective CABG as the primary revascularization procedure (group 1) were evaluated for in-hospital mortality and major adverse cardiac events (MACEs) and were compared with 360 patients after single PCI (group 2) and with 289 patients after multiple PCI sessions (group 3) before elective CABG. Unadjusted univariate and risk-adjusted multivariate logistic-regression analysis revealed previous multiple PCIs to be strongly associated with in-hospital mortality (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.52 to 3.21; P<0.001) and MACEs (OR, 2.28; 95% CI, 1.38 to 3.59; P<0.001). To control for selection bias, a computed propensity-score matching based on 13 patient characteristics and preoperative risk factors was performed separately comparing group 1 versus 2 and group 1 versus 3. After propensity matching, conditional logistic-regression analysis confirmed previous multiple PCIs to be strongly associated with in-hospital mortality (OR, 3.01; 95% CI, 1.51 to 5.98; P<0.0017) and MACEs (OR, 2.31; 95% CI, 1.45 to 3.67; P<0.0004).

Conclusions— In patients with a history of multiple PCI sessions, perioperative risk for in-hospital mortality and MACEs during subsequent elective CABG is increased.

Key Words: arteries • bypass • coronary disease • prognosis • surgery