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  • Impact of prior percutaneou...
    Massoudy, Parwis, MD; Thielmann, Matthias, MD; Lehmann, Nils, PhD; Marr, Anja, PhD; Kleikamp, Georg, MD; Maleszka, Ariane, MD; Zittermann, Armin, MD; Körfer, Reiner, MD; Radu, Miriam, MD; Krian, Arno, MD; Litmathe, Jens, MD; Gams, Emmeran, MD; Sezer, Ömer, MD; Scheld, Hans, MD; Schiller, Wolfgang, MD; Welz, Armin, MD; Dohmen, Guido, MD; Autschbach, Rüdiger, MD; Slottosch, Ingo, MD; Wahlers, Thorsten, MD; Neuhäuser, Markus, PhD; Jöckel, Karl-Heinz, PhD; Jakob, Heinz, MD

    Journal of thoracic and cardiovascular surgery/ˆThe ‰Journal of thoracic and cardiovascular surgery/˜The œjournal of thoracic and cardiovascular surgery, 04/2009, Volume: 137, Issue: 4
    Journal Article

    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.