Effect of Multiple Prior Percutaneous Coronary Interventions on Outcomes After Coronary Artery Bypass Grafting

• Published in: Circulation Journal Vol. 85; no. 6; pp. 850 - 856
• Main Authors: Hakamada, Keisuke, Sakaguchi, Genichi, Marui, Akira, Arai, Yoshio, Nagasawa, Atsushi, Tsumaru, Shinichi, Hanyu, Michiya, Soga, Yoshiharu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.05.2021
• Subjects: Coronary Artery Bypass; Coronary artery bypass grafting; Coronary artery disease; Coronary Artery Disease - surgery; Drug-Eluting Stents; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Risk Factors; Stroke; Time Factors; Treatment Outcome; Coronary artery disease; Coronary artery bypass grafting; Percutaneous coronary intervention
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-0421

Background:The effect of multiple prior percutaneous coronary interventions (PCIs) before subsequent coronary artery bypass grafting (CABG) on long-term outcomes has not been well elucidated.Methods and Results:Between 2007 and 2016, 1,154 patients undergoing primary isolated CABG in our institution had no prior PCI (Group N), 225 had a single prior PCI (Group S), and 272 had multiple prior PCIs (Group M). Cumulative incidences of all-cause death, cardiac death and myocardial infarction (MI) at 10 years post-CABG were highest in Group M. After adjusting for confounders, the risk of all-cause death was higher in Group M than in Group N (hazard ratio [HR] 1.45; 95% confidence interval [CI], 1.10–1.91; P<0.01). Between Groups N and S, however, the risk of all-cause death was not different. The risks of cardiac death and MI were likewise higher in Group M than in Group N (HR, 2.39; 95% CI, 1.55–3.71; P<0.01 and HR, 3.65; 95% CI, 1.16–11.5; P=0.03, respectively), but not different between Groups N and S. The risk of repeat revascularization was not different among any of the groups.Conclusions:Multiple prior PCIs was associated with higher risks of long-term death and cardiovascular events. The incidence of repeat revascularization after CABG was low regardless of the history of single/multiple PCIs.