Abstract P348: Coronary Revascularization Procedure Mortality in Patients with Coexisting Pneumoconiosis: Outcomes after Coronary Artery Bypass Grafting and Angioplasty are Similar
Background: Diminished respiratory capacity due to excessive development of fibrous tissue in the lungs (pneumofibroisis) can pose a serious challenge for cardiovascular interventional therapy procedures and have a negative effect on the outcome of the procedure. Progressive massive fibrosis is characteristic of pneumoconiosis (PNC) - a chronic respiratory disease that develops as a result of an occupational exposure to dust (such as coal dust etc.) via inhalation. Coronary heart disease (CHD) patients with co-existing pneumofibrosis can constitute a vulnerable group of a higher risk of the unfavorable outcome of coronary revascularization procedures, especially of more invasive procedures such as coronary artery bypass grafting (CABG) rather than a less invasive percutaneous transluminal coronary angioplasty (PTCA). However, procedure mortality after CABG vs. PTCA in CHD patients with co-existing PNC (CHD/PNC) remains an open question.
Hypothesis: We conducted a retrospective cohort study to investigate whether post-CABG mortality in CHD/PNC patients is higher than post-PTCA mortality.
Methods: We investigated post-procedure mortality after CABG vs, PTCA in 1,070 male CHD/PNC patients, 75.8+10.3 years of age (mean+standard deviation). Study subjects were only men because it is men who are typically mployed in occupations associated with PNC, such as coal mining. The outcome of interest - in-hospital patient death - was a binary variable, and adjusted odds ratios (OR) for in-hospital death were calculated using multivariable logistic regression, adjusting for a number of confounders, including patient demographic characteristics, clinical characteristics, and socio-economic status. Results: Most of CABG and PTCA procedures [76.78% (822 of 1,070)] were performed in urban area hospitals. In the bivariate unadjusted (crude) analysis, post-CABG in-hospital mortality did not differ significantly from post-PTCA in-hospital mortality (1.42% and 2.01%; p=0.435). In the adjusted multivariable analysis, this difference remained statistically non-significant (adjusted OR = 1.240, 95% CI: 0.418-3.681; p=0.698). Post-coronary revascularization procedure mortality was statistically significantly higher in older patients, with adjusted OR increasing by 9.4% for every year of age (adjusted OR = 1.094, 95%CI: 1.025-1.167; p=0.007).
Conclusions: In CHD/PNC patients, post-CABG in-hospital mortality is similar to post-PTCA in-hospital mortality. The absence of increased procedure mortality after CABG, as compared to after PTCA (a less invasive procedure), may reflect a more careful selection of candidate patients for a more invasive procedure (CABG) from among CHD/PNC patients with diminished respiratory capacity. Further studies investigating longer term mortality in CHD/PNC patients are warranted.
- © 2013 by American Heart Association, Inc.