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J Thorac Cardiovasc Surg 2009;138:790
© 2009 The American Association for Thoracic Surgery

Letter to the Editor

The link between previous percutaneous coronary intervention and coronary artery bypass graft risk

^a Department of Cardiology, Royal North Shore Hospital, St Leonards, Sydney, Australia
^b Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom

To the Editor:

We read with interest the publication by Massoudy and colleagues,¹ who observed a higher rate of in hospital mortality and major adverse cardiac events in patients undergoing coronary artery bypass graft surgery with two or more previous percutaneous coronary interventions (PCIs). We wish to raise a few important issues that need to be considered when interpreting this study. First, multivariate analysis has limitations as a statistical tool in a context such as this, where a vastly disproportionate number of patients in each group could lead to inappropriate identification of meaningful predictors. Second, inasmuch as there is minimal clinical characterization of patients in this study, the reasons for initial multivessel PCI are likely to be important and may reflect patients undergoing PCI after being thought to be at too high a risk for initial coronary bypass surgery or being undertaken as urgent cases. Finally, another explanation for increased events in this cohort may be that these patients have declared themselves as a high-risk population, having had unsuccessful medical therapy and PCI,² and not as a direct consequence of prior stenting alone.

References

1. Massoudy P, Thielmann M, Lehmann N, Marr A, Kleikamp G, Maleszka A, et al. Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis. J Thorac Cardiovasc Surg 2009;137:840-845.[Abstract/Free Full Text]
   
2. Bhindi R, Van Gaal W, Testa L. Perspectives on patients with diabetes mellitus and triple-vessel disease undergoing coronary artery bypass grafting after previous percutaneous coronary intervention. J Thorac Cardiovasc Surg 2008;135:1400.[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bhindi, R. Articles by Omerod, O. J. Search for Related Content PubMed PubMed Citation Articles by Bhindi, R. Articles by Omerod, O. J. Related Collections Coronary disease Related Articles