Abstract 16375: PCI Prior to CABG During the Same Admission is Associated With Increased In-Hospital Mortality and Increased Cost: A Propensity Adjusted Analysis of the Nationwide Inpatient Sample
Introduction: Previous studies are inconclusive on the effect of PCI prior to coronary artery bypass grafting (CABG) on mortality.
Hypothesis: CABG performed after PCI during the same admission is associated with increased in-hospital mortality.
Methods: Patients undergoing CABG were abstracted from the Nationwide Inpatient Sample 2007-2010. Patients undergoing PCI prior to CABG during the same hospitalization were compared to those undergoing CABG only. Propensity matched multivariate logistic regression was used to reduce bias while identifying associations with in-hospital mortality.
Results: 931,572 patients underwent CABG. Of these, 1087 patients underwent PCI a mean of 4.3 days prior to CABG. Patients undergoing PCI were younger (62.9 vs. 66.1 years, p<0.0001) and less likely to be admitted electively (13% vs. 47.8%, p<0.0001). They were more likely to be Hispanic (9.8% vs. 6.8% p=0.0336). They were more likely to have CHF (2.3% vs. 1.1%, p=0.0055), and smoke (39.5% vs. 34.5%, p=0.0054), but not hypertension (67.6% vs. 73.1%, p=0.0038). There was no difference in gender, obesity, valve disease, diabetes, chronic lung disease or median household income. Patients were more likely to undergo PCI prior to CABG in large hospitals (78.7% vs. 74.6%, p=0.0327) and in urban non-teaching hospitals (46.6% vs. 39.2%), but not in urban teaching hospitals (49.4% vs. 55.7%); p=0.0319. The PCI group had greater length of stay (12.9 vs. 9.9 days, p<0.0001) and cost of care ($62,131 vs. $40,418, p<0.0001). Propensity matched multivariate logistic regression found that prior stenting was associated with in-hospital mortality after CABG (OR: 1.613, CI: 1.068-2.435, p=0.0230). Other factors associated with mortality were age (OR: 1.047, p<0.0001), female gender (OR: 1.515, p<0.0001), CHF (OR: 2.265, p<0.0001), concomitant valve disease (OR: 1.956, p<0.0001), chronic lung disease (OR: 1.123, p=0.0203) and renal failure (OR: 2.159, p<0.0001).
Conclusions: PCI prior to CABG is associated with increased in-hospital mortality, and 50% more cost if performed during the same hospitalization. The decision to offer PCI to patients who may otherwise be acceptable candidates for CABG during the same admission should be taken deliberately.
- © 2013 by American Heart Association, Inc.