| Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis. | |
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MedLine Citation:
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PMID: 19327506 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Parwis Massoudy; Matthias Thielmann; Nils Lehmann; Anja Marr; Georg Kleikamp; Ariane Maleszka; Armin Zittermann; Reiner Körfer; Miriam Radu; Arno Krian; Jens Litmathe; Emmeran Gams; Omer Sezer; Hans Scheld; Wolfgang Schiller; Armin Welz; Guido Dohmen; Rüdiger Autschbach; Ingo Slottosch; Thorsten Wahlers; Markus Neuhäuser; Karl-Heinz Jöckel; Heinz Jakob |
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Publication Detail:
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Type: Journal Article; Multicenter Study Date: 2009-01-18 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 137 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-30 Completed Date: 2009-04-15 Revised Date: 2009-08-24 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 840-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen, Germany. parwis.massoudy@uk-essen.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / adverse effects* Cohort Studies Coronary Artery Bypass / adverse effects, mortality* Coronary Artery Disease / surgery* Female Germany Heart Diseases / epidemiology, etiology Hospital Mortality Humans Incidence Male Middle Aged Recurrence Reoperation / mortality Retrospective Studies Risk Factors Treatment Outcome |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2009 Sep;138(3):790; author reply 790
[PMID:
19698888
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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