Document Detail


Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis.
MedLine Citation:
PMID:  19327506     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Multicenter Study     Date:  2009-01-18
Journal Detail:
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:
Created Date:  2009-03-30     Completed Date:  2009-04-15     Revised Date:  2009-08-24    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  840-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen, Germany. parwis.massoudy@uk-essen.de
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MeSH Terms
Descriptor/Qualifier:
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:
J Thorac Cardiovasc Surg. 2009 Sep;138(3):790; author reply 790   [PMID:  19698888 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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