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J Thorac Cardiovasc Surg 2009;137:840-845
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: A multicenter analysis

^a Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Germany
^b Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
^c Department of Thoracic and Cardiovascular Surgery, The Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Ruhr University of Bochum, Bochum, Germany
^d Department of Thoracic and Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
^e Department of Thoracic and Cardiovascular Surgery, Heinrich Heine-University, Düsseldorf, Germany
^f Department of Thoracic and Cardiovascular Surgery, University Hospital Münster, Münster, Germany
^g Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
^h Department of Thoracic and Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
ⁱ Department of Cardiothoracic Surgery, Cologne University Hospital, Cologne, Germany
^j Department of Mathematics and Technique, Rhein Ahr Campus Remagen, Koblenz University of Applied Science for the NRW (North Rhine-Westphalia) CABG Study group, Koblenz, Germany

Received for publication June 24, 2008; revisions received August 20, 2008; accepted for publication September 3, 2008.

^_* Address for reprints: Parwis Massoudy, MD, Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, Hufelandstr. 55, 45147 Essen, Germany. (Email: parwis.massoudy{at}uk-essen.de).

Objectives: Do prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis.

Methods: Eight cardiac surgical centers provided outcome data of 37,140 consecutive patients who underwent isolated first-time coronary bypass grafting between January 2000 and December 2005. Twenty-two patient characteristics and outcome variables were retrieved. Three groups of patients were analysed for in-hospital mortality and in-hospital major adverse cardiac events: patients without a previous percutaneous coronary intervention, with 1 previous intervention, and with 2 or more previous percutaneous coronary interventions before bypass grafting. A total of 29,928 patients with complete information for prior percutaneous coronary intervention underwent final analysis. Unadjusted univariate and risk-adjusted multivariate logistic regression analysis as well as computed propensity score matching were performed, based on 14 major risk factors to correct for and minimize selection bias.

Results: A total of 10.3% of patients had 1 previous percutaneous coronary intervention, and 3.7% of patients had 2 or more previous interventions. Risk-adjusted multivariate logistic regression analysis revealed a significant association of 2 or more previous percutaneous coronary interventions with in-hospital mortality (odds ratio [OR], 2.0; confidence interval [CI], 1.4–3.0; P = .0005) and major adverse cardiac events (OR, 1.5; CI, 1.2–1.9; P = .0013). After propensity score matching, conditional logistic regression analysis confirmed the results of adjusted analysis. A history of 2 or more previous percutaneous coronary interventions was significantly associated with in-hospital mortality (OR, 1.9; CI, 1.3–2.7; P = .0016) and major adverse cardiac events (OR, 1.5; CI, 1.2–1.9; P = .0019).

Conclusions: Multicenter analysis confirms that a history of multiple previous percutaneous coronary interventions increases in-hospital mortality and the incidence of major adverse cardiac events after subsequent coronary artery bypass grafting. Critical discussion of the treatment strategy in these patients is warranted.

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