Prior Coronary Artery Bypass Graft Surgery and Outcome After Percutaneous Coronary Intervention: An Observational Study From the Pan-London Percutaneous Coronary Intervention Registry.

Autor: Rathod KS; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom., Beirne AM; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom.; Imperial College Healthcare National Health Service Foundation Trust Hammersmith Hospital London United Kingdom., Bogle R; St. George's Healthcare National Health Service Foundation Trust St. George's Hospital London United Kingdom., Firoozi S; St. George's Healthcare National Health Service Foundation Trust St. George's Hospital London United Kingdom., Lim P; St. George's Healthcare National Health Service Foundation Trust St. George's Hospital London United Kingdom., Hill J; Kings College Hospital King's College Hospital National Health Service Foundation Trust London United Kingdom., Dalby MC; Royal Brompton & Harefield National Health Service Foundation Trust Harefield Hospital Uxbridge United Kingdom., Jain AK; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom., Malik IS; Imperial College Healthcare National Health Service Foundation Trust Hammersmith Hospital London United Kingdom., Mathur A; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom., Kalra SS; Royal Free London National Health Service Foundation Trust London United Kingdom., DeSilva R; Royal Brompton & Harefield National Health Service Foundation Trust Harefield Hospital Uxbridge United Kingdom., Redwood S; St Thomas' National Health Service Foundation Trust Guys & St. Thomas Hospital London United Kingdom., MacCarthy PA; Kings College Hospital King's College Hospital National Health Service Foundation Trust London United Kingdom., Wragg A; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom., Smith EJ; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom., Jones DA; Barts Heart Centre Barts Health National Health Service Trust London United Kingdom.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2020 Jun 16; Vol. 9 (12), pp. e014409. Date of Electronic Publication: 2020 Jun 01.
DOI: 10.1161/JAHA.119.014409
Abstrakt: Background Limited information exists regarding procedural success and clinical outcomes in patients with previous coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without CABG. Methods and Results This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry from 2005 to 2015. The primary end point was all-cause mortality at a median follow-up of 3.0 years (interquartile range, 1.2-4.6 years). A total of 12 641(10.2%) patients had a history of previous CABG, of whom 29.3% (n=3703) underwent PCI to native vessels and 70.7% (n=8938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%; P =0.0005) compared with patients with no prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%; P <0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (hazard ratio [HR],1.02; 95%CI, 0.77-1.34; P =0.89), but a significantly higher mortality was seen among patients with PCI to bypass grafts (HR,1.33; 95% CI, 1.03-1.71; P =0.026). This was seen after multivariate adjustment and propensity matching. Conclusions Patients with prior CABG were older with greater comorbidities and more complex procedural characteristics, but after adjustment for these differences, the clinical outcomes were similar to the patients undergoing PCI without prior CABG. In these patients, native-vessel PCI was associated with better outcomes compared with the treatment of vein grafts.
Databáze: MEDLINE
Externí odkaz: