Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting

Fausto Biancari, Magnus Dalšen, Vito G. Ruggieri, Till Demal, Giuseppe Gatti, Francesco Onorati, Giuseppe Faggian, Antonino S. Rubino, Daniele Maselli, Riccardo Gherli, Antonio Salsano, Matteo Saccocci, Giuseppe Santarpino, Francesco Nicolini, Tuomas Tauriainen, Marisa De Feo, Juhani Airaksinen, Stefano Rosato, Andrea Perrotti, Giovanni Mariscalco

Research output: Contribution to journalArticle

Abstract

Background-—Multiple percutaneous coronary interventions (PCIs) are considered determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but scarce data exist to substantiate this. Methods and Results-—Patients who underwent CABG without history of prior PCI or with PCI performed >30 days before surgery were selected for the present analysis from the prospective, multicenter E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) registry. Out of 6563 patients with data on preoperative SYNTAX (Synergy between PCI With Taxus and Cardiac Surgery) score, 1181 patients (18.0%) had undergone PCI >30 days before CABG. Of these, 11.6% underwent a single PCI, 4.4% 2 PCIs, and 2.1% ≥3 PCIs. PCI of a single main coronary vessel was performed in 11.3%, of 2 main vessels in 4.9%, and of 3 main vessels in 1.6% of patients. Multivariable analysis showed that differences in early mortality and other outcomes were not significantly different in the study cohorts. The adjusted hospital/30-day mortality rate was 1.8% in patients without history of prior PCI, 1.9% in those with a history of 1 PCI, 1.4% after 2 PCIs, and 2.5% after ≥3 PCIs (adjusted P=0.8). The adjusted hospital/30-day mortality rate was 2.0% in those who had undergone PCI of 1 main coronary vessel, 1.3% after PCI of 2 main vessels, and 3.1% after PCI of 3 main coronary vessels (adjusted P=0.6). Conclusions-—Multiple prior PCIs are not associated with increased risk of early adverse events in patients undergoing isolated CABG. The present results are conditional to survival after PCI and should not be viewed as a support for a policy of multiple PCI as opposed to earlier CABG.

Original languageEnglish
Article numbere010089
JournalJournal of the American Heart Association
Volume7
Issue number20
DOIs
Publication statusPublished - Oct 1 2018

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Vessels
Mortality
Taxus

Keywords

  • Coronary artery bypass grafting
  • Percutaneous coronary intervention
  • Previous PCI
  • Prior PCI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting. / Biancari, Fausto; Dalšen, Magnus; Ruggieri, Vito G.; Demal, Till; Gatti, Giuseppe; Onorati, Francesco; Faggian, Giuseppe; Rubino, Antonino S.; Maselli, Daniele; Gherli, Riccardo; Salsano, Antonio; Saccocci, Matteo; Santarpino, Giuseppe; Nicolini, Francesco; Tauriainen, Tuomas; De Feo, Marisa; Airaksinen, Juhani; Rosato, Stefano; Perrotti, Andrea; Mariscalco, Giovanni.

In: Journal of the American Heart Association, Vol. 7, No. 20, e010089, 01.10.2018.

Research output: Contribution to journalArticle

Biancari, F, Dalšen, M, Ruggieri, VG, Demal, T, Gatti, G, Onorati, F, Faggian, G, Rubino, AS, Maselli, D, Gherli, R, Salsano, A, Saccocci, M, Santarpino, G, Nicolini, F, Tauriainen, T, De Feo, M, Airaksinen, J, Rosato, S, Perrotti, A & Mariscalco, G 2018, 'Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting', Journal of the American Heart Association, vol. 7, no. 20, e010089. https://doi.org/10.1161/JAHA.118.010089
Biancari, Fausto ; Dalšen, Magnus ; Ruggieri, Vito G. ; Demal, Till ; Gatti, Giuseppe ; Onorati, Francesco ; Faggian, Giuseppe ; Rubino, Antonino S. ; Maselli, Daniele ; Gherli, Riccardo ; Salsano, Antonio ; Saccocci, Matteo ; Santarpino, Giuseppe ; Nicolini, Francesco ; Tauriainen, Tuomas ; De Feo, Marisa ; Airaksinen, Juhani ; Rosato, Stefano ; Perrotti, Andrea ; Mariscalco, Giovanni. / Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 20.
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abstract = "Background-—Multiple percutaneous coronary interventions (PCIs) are considered determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but scarce data exist to substantiate this. Methods and Results-—Patients who underwent CABG without history of prior PCI or with PCI performed >30 days before surgery were selected for the present analysis from the prospective, multicenter E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) registry. Out of 6563 patients with data on preoperative SYNTAX (Synergy between PCI With Taxus and Cardiac Surgery) score, 1181 patients (18.0{\%}) had undergone PCI >30 days before CABG. Of these, 11.6{\%} underwent a single PCI, 4.4{\%} 2 PCIs, and 2.1{\%} ≥3 PCIs. PCI of a single main coronary vessel was performed in 11.3{\%}, of 2 main vessels in 4.9{\%}, and of 3 main vessels in 1.6{\%} of patients. Multivariable analysis showed that differences in early mortality and other outcomes were not significantly different in the study cohorts. The adjusted hospital/30-day mortality rate was 1.8{\%} in patients without history of prior PCI, 1.9{\%} in those with a history of 1 PCI, 1.4{\%} after 2 PCIs, and 2.5{\%} after ≥3 PCIs (adjusted P=0.8). The adjusted hospital/30-day mortality rate was 2.0{\%} in those who had undergone PCI of 1 main coronary vessel, 1.3{\%} after PCI of 2 main vessels, and 3.1{\%} after PCI of 3 main coronary vessels (adjusted P=0.6). Conclusions-—Multiple prior PCIs are not associated with increased risk of early adverse events in patients undergoing isolated CABG. The present results are conditional to survival after PCI and should not be viewed as a support for a policy of multiple PCI as opposed to earlier CABG.",
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AU - Biancari, Fausto

AU - Dalšen, Magnus

AU - Ruggieri, Vito G.

AU - Demal, Till

AU - Gatti, Giuseppe

AU - Onorati, Francesco

AU - Faggian, Giuseppe

AU - Rubino, Antonino S.

AU - Maselli, Daniele

AU - Gherli, Riccardo

AU - Salsano, Antonio

AU - Saccocci, Matteo

AU - Santarpino, Giuseppe

AU - Nicolini, Francesco

AU - Tauriainen, Tuomas

AU - De Feo, Marisa

AU - Airaksinen, Juhani

AU - Rosato, Stefano

AU - Perrotti, Andrea

AU - Mariscalco, Giovanni

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background-—Multiple percutaneous coronary interventions (PCIs) are considered determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but scarce data exist to substantiate this. Methods and Results-—Patients who underwent CABG without history of prior PCI or with PCI performed >30 days before surgery were selected for the present analysis from the prospective, multicenter E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) registry. Out of 6563 patients with data on preoperative SYNTAX (Synergy between PCI With Taxus and Cardiac Surgery) score, 1181 patients (18.0%) had undergone PCI >30 days before CABG. Of these, 11.6% underwent a single PCI, 4.4% 2 PCIs, and 2.1% ≥3 PCIs. PCI of a single main coronary vessel was performed in 11.3%, of 2 main vessels in 4.9%, and of 3 main vessels in 1.6% of patients. Multivariable analysis showed that differences in early mortality and other outcomes were not significantly different in the study cohorts. The adjusted hospital/30-day mortality rate was 1.8% in patients without history of prior PCI, 1.9% in those with a history of 1 PCI, 1.4% after 2 PCIs, and 2.5% after ≥3 PCIs (adjusted P=0.8). The adjusted hospital/30-day mortality rate was 2.0% in those who had undergone PCI of 1 main coronary vessel, 1.3% after PCI of 2 main vessels, and 3.1% after PCI of 3 main coronary vessels (adjusted P=0.6). Conclusions-—Multiple prior PCIs are not associated with increased risk of early adverse events in patients undergoing isolated CABG. The present results are conditional to survival after PCI and should not be viewed as a support for a policy of multiple PCI as opposed to earlier CABG.

AB - Background-—Multiple percutaneous coronary interventions (PCIs) are considered determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but scarce data exist to substantiate this. Methods and Results-—Patients who underwent CABG without history of prior PCI or with PCI performed >30 days before surgery were selected for the present analysis from the prospective, multicenter E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) registry. Out of 6563 patients with data on preoperative SYNTAX (Synergy between PCI With Taxus and Cardiac Surgery) score, 1181 patients (18.0%) had undergone PCI >30 days before CABG. Of these, 11.6% underwent a single PCI, 4.4% 2 PCIs, and 2.1% ≥3 PCIs. PCI of a single main coronary vessel was performed in 11.3%, of 2 main vessels in 4.9%, and of 3 main vessels in 1.6% of patients. Multivariable analysis showed that differences in early mortality and other outcomes were not significantly different in the study cohorts. The adjusted hospital/30-day mortality rate was 1.8% in patients without history of prior PCI, 1.9% in those with a history of 1 PCI, 1.4% after 2 PCIs, and 2.5% after ≥3 PCIs (adjusted P=0.8). The adjusted hospital/30-day mortality rate was 2.0% in those who had undergone PCI of 1 main coronary vessel, 1.3% after PCI of 2 main vessels, and 3.1% after PCI of 3 main coronary vessels (adjusted P=0.6). Conclusions-—Multiple prior PCIs are not associated with increased risk of early adverse events in patients undergoing isolated CABG. The present results are conditional to survival after PCI and should not be viewed as a support for a policy of multiple PCI as opposed to earlier CABG.

KW - Coronary artery bypass grafting

KW - Percutaneous coronary intervention

KW - Previous PCI

KW - Prior PCI

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