Abstract 1848: Coronary Artery Bypass Grafting after Uneventful Percutaneous Coronary Intervention in the Commonwealth of Massachusetts
Objective: Percutaneous coronary intervention (PCI) is associated with an increase in coronary re-intervention and cardiac re-hospitalization compared to CABG. We compared mid-term survival of adults undergoing primary isolated CABG more than 14 days and within 5 years of a PCI (P-PCI) to CABG patients without prior PCI (NO-PCI).
Methods: We linked clinical information from the mandatory MA Adult Cardiac Surgery Database to the MA Inpatient Acute Hospital Case Mix, Charge Database and to the MA Mortality Index Database in order to analyze outcomes of 11,352 adults undergoing primary isolated CABG between 2002 and 2004. Inpatient discharge data were used to identify any occurrence of P-PCI in the 5 years interval prior to the primary CABG. We excluded patients residing outside of MA at time of primary CABG (n = 1,043), with early PCI failure < 14 days prior to CABG (n = 403), or rescue PCI for acute myocardial infarction (n = 438), leaving a final cohort of 9,468. The propensity for P-PCI was determined by logistic regression analysis and each patient with P-PCI was matched to a single NO-PCI patient. Morbidity and mortality differences were estimated by McNemar’s test and length of stay by paired t-tests. Survival was compared using Cox proportional hazards model to account for matching.
Results: We identified 1,033 patients with P-PCI; the median interval between P-PCI and CABG was 234 days. P-PCI patients were more likely to be younger, female, with lower ejection fraction, hypertension, myocardial infarction > 24 hrs and fewer diseased vessels. They were less likely to present with peripheral vascular disease, left main disease and to present in urgent status. Mean follow-up was 578 ± 316 days and was 100% complete. Using 1,032 matched pairs, no differences were found (P-PCI vs. NO-PCI) in 30-day mortality (1.1% vs. 1.4%; P = 0.7), hospital morbidity (35% vs. 33%; P = 0.4), median length of stay (8 days vs. 9 days; P = 0.06), and survival (HR [95% CI] for P-PCI = 0.88 [0.56, 1.38]; P = 0.6).
Conclusions: Although CABG patients with P-PCI presented with more comorbidities, mid-term outcomes were similar to a matched NO-PCI CABG population. These results help to refine the indications and trade-offs for the available successful alternatives in coronary revascularization.