Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting.
coronary artery bypass grafting
graft failure
percutaneous coronary intervention
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
05 02 2019
05 02 2019
Historique:
received:
11
09
2018
accepted:
22
10
2018
entrez:
2
2
2019
pubmed:
2
2
2019
medline:
22
11
2019
Statut:
ppublish
Résumé
Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce. The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG. This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses. Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p < 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p < 0.001), acute kidney injury (16% vs. 12.3%; p < 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG. In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.
Sections du résumé
BACKGROUND
Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce.
OBJECTIVES
The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG.
METHODS
This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses.
RESULTS
Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p < 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p < 0.001), acute kidney injury (16% vs. 12.3%; p < 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG.
CONCLUSIONS
In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.
Identifiants
pubmed: 30704573
pii: S0735-1097(18)39308-2
doi: 10.1016/j.jacc.2018.10.071
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
415-423Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.