Increased mortality and perioperative complications in patients with previous elective percutaneous coronary interventions undergoing coronary artery bypass surgery

Abstract

Objective: The relationship between previous percutaneous coronary intervention and perioperative outcome after coronary artery bypass grafting remains undetermined. The aim of the study was to investigate whether previous elective percutaneous coronary intervention influences the outcome of elective coronary artery bypass grafting.

Methods: Between 2002 and 2007, 4412 consecutive patients underwent first-time open surgery at the Innsbruck Medical University. After excluding patients with a history of emergency percutaneous coronary intervention, we isolated 306 patients with elective percutaneous coronary intervention during the last 24 months before isolated coronary artery bypass grafting (group 1). Those patients were compared with 452 consecutive age-, gender-, and EuroSCORE-matched patients without a history of percutaneous coronary intervention (group 2), in terms of 30-day mortality, major adverse cardiac events, and perioperative complications.

Results: Both groups were comparable concerning preoperative linear EuroSCORE (group 1: 4.83 +/- 0.18, group 2: 4.72 +/- 0.14, P = .63). Patients who underwent previous elective percutaneous coronary intervention before coronary artery bypass grafting had an increase in perioperative mortality (group 1: 4.4% vs group 2: 2.4%, P < .001) and major adverse cardiac events (group 1: 7.9% vs 4.3%, P < .001). In addition, the incidence of bleeding complications (group 1: 5.9% vs group 2: 3.8%, P = .017) and the number of blood products (group 1: 1.70 +/- 0.31 vs 0.61 +/- 0.17, P < .001) used were higher in patients of group 1. A higher incidence of acute renal failure (5.9% vs 2.7%, P = .025) and renal replacement therapy (3.6% vs 1.7%, P = .03) was observed in patients of group 1.

Conclusion: Patients with a history of elective percutaneous coronary intervention before referral to coronary artery bypass grafting have a worse perioperative outcome in terms of mortality, major adverse cardiac events, and perioperative complications compared with patients without a history of percutaneous coronary intervention. This fact should be considered in risk stratification for patients who are scheduled for elective coronary artery bypass grafting.