Influence of prior percutaneous coronary intervention on outcome of coronary artery bypass grafting: A multi-center clinical study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Hongwei ¹ , ZHANG Hang ¹ , CHEN Wen ¹ , ZHENG Fangjing ¹ , SHAO Yongfeng ² , QIAN Yongxiang ³ , WANG Guoxiang ⁴ , LI Mingqiu ⁵ , YOU Qingsheng ⁶ , LIU Zhiyong ⁷ , WANG Yong ⁸ , SHEN Zhenya ⁹ , LI Wei ¹⁰ , LI Demin ¹¹ , HUANG Su ¹² , ZHONG Chongjun ¹³ ,  WANG Rui ¹ ,  CHEN Xin ¹

1. Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, P. R. China;
2. Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;
3. Department of Thoracic and Cardiac Surgery, The First People’s Hospital of Changzhou, Changzhou, 213003, Jiangsu, P. R. China;
4. Department of Thoracic and Cardiac Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, P. R. China;
5. Department of Cardiac Surgery, Wuxi People's Hospital, Wuxi, 214023, Jiangsu, P. R. China;
6. Department of Thoracic and Cardiac Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, P. R. China;
7. Department of Thoracic and Cardiac Surgery, Zhongda Hospital, Nanjing, 210009, P. R. China;
8. Department of Thoracic and Cardiac Surgery, The Second People’s Hospital of Changzhou, Changzhou, 213003, Jiangsu, P. R. China;
9. Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, P. R. China;
10. Department of Cardiac Surgery, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P. R. China;
11. Department of Thoracic and Cardiac Surgery, General Hospital of Eastern Theater Command, Nanjing, 210002, P. R. China;
12. Department of Cardiovascular Surgery, Huaian First People’s Hospital, Huaian, 223300, Jiangsu, P. R. China;
13. Department of Thoracic and Cardiovascular Surgery, Nantong First People’s Hospital, Nantong, 226001, Jiangsu, P. R. China;

Corresponding author：

WANG Rui, Email: wr1582@163.com; CHEN Xin, Email: stevecx@njmu.edu.cn

Keywords：

Percutaneous coronary intervention; coronary artery bypass grafting; follow-up; clinical outcome; multi-center; clinical study

DOI：

10.7507/1007-4848.202110029

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Objective To investigate the influence of prior percutaneous coronary intervention (PCI) on the outcome of coronary artery bypass grafting (CABG). Methods Clinical data of 5 216 patients from Jiangsu Province CABG registry who underwent primary isolated CABG from 2016 to 2019 were retrospectively analyzed. Patients were divided into a PCI group (n=673) and a non-PCI group (n=4 543) according to whether they had received PCI treatment. The PCI group included 491 males and 182 females, aged 62.6±8.2 years, and the non-PCI group included 3 335 males and 1 208 females, aged 63.7±8.7 years. Multivariable logistic regression and propensity score matching (PSM) were used to compare 30-day mortality, incidence of major complications and 1-year follow-up outcomes between the two groups. Results Both in original cohort and matched cohort, there was no statistical difference in the 30-day mortality [14 (2.1%) vs. 77 (1.7%), P=0.579; 14 (2.1%) vs. 11 (1.6%), P=0.686], or the incidence of major complications (myocardial infarction, stroke, mechanical ventilation≥24 h, dialysis for new-onset renal failure, deep sternal wound infection and atrial fibrillation) (all P>0.05). The rate of reoperation for bleeding in the PCI group was higher than that in the non-PCI group [19 (2.8%) vs. 67 (1.5%), P=0.016; 19 (2.8%) vs. 7 (1.0%), P=0.029]. Both in original cohort and matched cohort, there was no statistical difference in 1-year survival rate between the two groups [613 (93.1%) vs. 4225 (94.6%), P=0.119; 613 (93.1%) vs. 630 (95.2%), P=0.124], while the re-admission rate in the PCI group was significantly higher than that in the non-PCI group [32 (4.9%) vs. 113 (2.5%), P=0.001; 32 (4.9%) vs. 17 (2.6%), P=0.040]. Conclusion This study shows that a history of PCI treatment does not significantly increase the perioperative mortality and major complications of CABG, but increases the rate of cardiogenic re-admission 1 year postoperatively.

Citation： JIANG Hongwei, ZHANG Hang, CHEN Wen, ZHENG Fangjing, SHAO Yongfeng, QIAN Yongxiang, WANG Guoxiang, LI Mingqiu, YOU Qingsheng, LIU Zhiyong, WANG Yong, SHEN Zhenya, LI Wei, LI Demin, HUANG Su, ZHONG Chongjun, WANG Rui, CHEN Xin. Influence of prior percutaneous coronary intervention on outcome of coronary artery bypass grafting: A multi-center clinical study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1436-1441. doi: 10.7507/1007-4848.202110029 Copy

1.	Holm NR, Mäkikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: Updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet, 2020, 395(10219): 191-199.
2.	Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
3.	Mehta GS, LaPar DJ, Bhamidipati CM, et al. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting. Surgery, 2012, 152(1): 5-11.
4.	Biancari F, Dalén M, Ruggieri VG, et al. Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting. J Am Heart Assoc, 2018, 7(20): e010089.
5.	Mannacio V, Di Tommaso L, De Amicis V, et al. Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery. Ann Thorac Surg, 2012, 93(6): 1956-1962.
6.	Bugajski P, Greberski K, Kuzemczak M, et al. Impact of previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting. Kardiol Pol, 2018, 76(6): 953-959.
7.	Ueki C, Sakaguchi G, Akimoto T, et al. Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass grafting: A meta-analysis of comparative studies. Interact Cardiovasc Thorac Surg, 2015, 20(4): 531-537.
8.	Kolh P, Windecker S. ESC/EACTS myocardial revascularization guidelines 2014. Eur Heart J, 2014, 35(46): 3235-3236.
9.	Nicolau JC, Stevens SR, Al-Khalidi HR, et al. Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. Int J Cardiol, 2019, 291: 36-41.
10.	Miguel GSV, Sousa AG, Silva GS, et al. Does prior percutaneous coronary intervention influence the outcomes of coronary artery bypass surgery? Braz J Cardiovasc Surg, 2020, 35(1): 1-8.
11.	Ueki C, Miyata H, Motomura N, et al. Previous percutaneous coronary intervention does not increase adverse events after coronary artery bypass surgery. Ann Thorac Surg, 2017, 104(1): 56-61.
12.	Stevens LM, Khairy P, Agnihotri AK. Coronary artery bypass grafting after recent or remote percutaneous coronary intervention in the Commonwealth of Massachusetts. Circ Cardiovasc Interv, 2010, 3(5): 460-467.
13.	Sánchez E, Cid-Cumplido M, Moreno-Millán E, et al. Previous percutaneous coronary intervention does not increase in-hospital mortality after surgical revascularization: Analysis of 63 420 cases. Rev Argent Cardiol, 2013, 81: 208-214.
14.	Fukui T, Tanaka S, Takanashi S. Previous coronary stents do not increase early and long-term adverse outcomes in patients undergoing off-pump coronary artery bypass grafting: A propensity-matched comparison. J Thorac Cardiovasc Surg, 2014, 148(5): 1843-1849.
15.	Mariscalco G, Rosato S, Serraino GF, et al. Prior percutaneous coronary intervention and mortality in patients undergoing surgical myocardial revascularization: Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) with a systematic review and meta-analysis. Circ Cardiovasc Interv, 2018, 11(2): e005650.
16.	张林, 高长青, 李伯君, 等. 既往经皮冠状动脉介入治疗对冠状动脉旁路手术结局的影响. 浙江大学学报(医学版), 2012, 41(2): 196-199, 209.

1. Holm NR, Mäkikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: Updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet, 2020, 395(10219): 191-199.
2. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
3. Mehta GS, LaPar DJ, Bhamidipati CM, et al. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting. Surgery, 2012, 152(1): 5-11.
4. Biancari F, Dalén M, Ruggieri VG, et al. Prognostic impact of multiple prior percutaneous coronary interventions in patients undergoing coronary artery bypass grafting. J Am Heart Assoc, 2018, 7(20): e010089.
5. Mannacio V, Di Tommaso L, De Amicis V, et al. Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery. Ann Thorac Surg, 2012, 93(6): 1956-1962.
6. Bugajski P, Greberski K, Kuzemczak M, et al. Impact of previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting. Kardiol Pol, 2018, 76(6): 953-959.
7. Ueki C, Sakaguchi G, Akimoto T, et al. Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass grafting: A meta-analysis of comparative studies. Interact Cardiovasc Thorac Surg, 2015, 20(4): 531-537.
8. Kolh P, Windecker S. ESC/EACTS myocardial revascularization guidelines 2014. Eur Heart J, 2014, 35(46): 3235-3236.
9. Nicolau JC, Stevens SR, Al-Khalidi HR, et al. Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial. Int J Cardiol, 2019, 291: 36-41.
10. Miguel GSV, Sousa AG, Silva GS, et al. Does prior percutaneous coronary intervention influence the outcomes of coronary artery bypass surgery? Braz J Cardiovasc Surg, 2020, 35(1): 1-8.
11. Ueki C, Miyata H, Motomura N, et al. Previous percutaneous coronary intervention does not increase adverse events after coronary artery bypass surgery. Ann Thorac Surg, 2017, 104(1): 56-61.
12. Stevens LM, Khairy P, Agnihotri AK. Coronary artery bypass grafting after recent or remote percutaneous coronary intervention in the Commonwealth of Massachusetts. Circ Cardiovasc Interv, 2010, 3(5): 460-467.
13. Sánchez E, Cid-Cumplido M, Moreno-Millán E, et al. Previous percutaneous coronary intervention does not increase in-hospital mortality after surgical revascularization: Analysis of 63 420 cases. Rev Argent Cardiol, 2013, 81: 208-214.
14. Fukui T, Tanaka S, Takanashi S. Previous coronary stents do not increase early and long-term adverse outcomes in patients undergoing off-pump coronary artery bypass grafting: A propensity-matched comparison. J Thorac Cardiovasc Surg, 2014, 148(5): 1843-1849.
15. Mariscalco G, Rosato S, Serraino GF, et al. Prior percutaneous coronary intervention and mortality in patients undergoing surgical myocardial revascularization: Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) with a systematic review and meta-analysis. Circ Cardiovasc Interv, 2018, 11(2): e005650.
16. 张林, 高长青, 李伯君, 等. 既往经皮冠状动脉介入治疗对冠状动脉旁路手术结局的影响. 浙江大学学报(医学版), 2012, 41(2): 196-199, 209.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of prior percutaneous coronary intervention on outcome of coronary artery bypass grafting: A multi-center clinical study

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