• 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, and Heinz Jakob.
• Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen, Germany. parwis.massoudy@uk-essen.de
• J. Thorac. Cardiovasc. Surg. 2009 Apr 1;137(4):840-5.

ObjectivesDo prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis.MethodsEight 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.ResultsA 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).ConclusionsMulticenter 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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