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

J Thorac Cardiovasc Surg. 2009 Apr;137(4):840-5. doi: 10.1016/j.jtcvs.2008.09.005. Epub 2009 Jan 18.


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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Cohort Studies
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / mortality*
  • Coronary Artery Disease / surgery*
  • Female
  • Germany
  • Heart Diseases / epidemiology
  • Heart Diseases / etiology
  • Hospital Mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Recurrence
  • Reoperation / mortality
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome