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Previous Percutaneous Coronary Interventions Increase Mortality and Morbidity After Coronary Surgery
- Source :
- The Annals of Thoracic Surgery. 93:1956-1962
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- This multicenter study investigated the impact of previous percutaneous coronary interventions (PCI) on postoperative outcome and 5-year survival of subsequent coronary artery bypass grafting.Among 7,855 patients who underwent isolated first-time coronary artery bypass grafting between January 2000 and December 2005, 6,834 (87%) had no previous PCI and 1,021 (13%) had previous PCI with stenting. Logistic multiple regression and propensity score analyses were used to assess the risk-adjusted impact of prior PCI on in-hospital mortality and major adverse cardiac events. The Cox regression model was used to assess the effect of prior PCI on 3-year and 5-year survival.After risk-adjusted multivariate analysis, age over 70 years, female sex, 3-vessel or 2-vessel plus left main coronary disease, multivessel PCI, ejection fraction 0.40 or less, diabetes mellitus, previous myocardial infarction, and chronic obstructive pulmonary disease were identified as independent predictors of both hospital mortality and major adverse cardiac events. After propensity score matching, conditional logistic regression analysis identified history of previous PCI as significantly associated with an increased risk for hospital mortality (odds ratio, 2.8; 95% confidence interval 1.4 to 4.8; p=0.003) and major adverse cardiac events (odds ratio 2.1; 95% confidence interval 1.2 to 3.6; p0.001). Survival at 3 and 5 years was lower in patients with previous PCI compared with the no-PCI patients (97.4%±0.01% vs 96.5%±0.02% and 94.2%±0.03% vs 92.1%±0.05%; log-rank test: p=0.03).Our results provided further evidence that history of PCI before coronary artery bypass grafting increases risk of both operative death and perioperative complications, and decreases survival at 5 years follow-up.
- Subjects :
- Male
Reoperation
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Coronary Disease
Comorbidity
Cohort Studies
Postoperative Complications
Recurrence
Risk Factors
Internal medicine
medicine
Humans
Hospital Mortality
cardiovascular diseases
Myocardial infarction
Angioplasty, Balloon, Coronary
Coronary Artery Bypass
Propensity Score
Aged
Ejection fraction
business.industry
Proportional hazards model
Odds ratio
Perioperative
medicine.disease
United States
Confidence interval
Survival Rate
surgical procedures, operative
Propensity score matching
Conventional PCI
Cardiology
Female
Stents
Surgery
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00034975
- Volume :
- 93
- Database :
- OpenAIRE
- Journal :
- The Annals of Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....5d4a2aca560ad31f45eb7c11479d3bcd