Akihiro Tokushige1, Hiroki Shiomi1, Takeshi Morimoto1, Koh Ono1, Yutaka Furukawa1, Yoshihisa Nakagawa1, Kazushige Kadota1, Kenji Ando1, Satoshi Shizuta1, Tomohisa Tada1, Junichi Tazaki1, Yoshihiro Kato1, Mamoru Hayano1, Mitsuru Abe1, Shuichi Hamasaki1, Mitsuru Ohishi1, Hitoshi Nakashima1, Kazuaki Mitsudo1, Masakiyo Nobuyoshi1, Toru Kita1, Yutaka Imoto1, Ryuzo Sakata1, Hitoshi Okabayashi1, Michiya Hanyu1, Mitsuomi Shimamoto1, Noboru Nishiwaki1, Tatsuhiko Komiya1, Takeshi Kimura2. 1. From the Department of Cardiovascular Medicine and Hypertension (A.T., S.H., M.O.), and Cardiovascular and Gastoroenterological Surgery, Advanced Therapeutics Cardiovascular and Respiratory Disorders (Y.I.), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Department of Cardiovascular Medicine (H.S., K.O., S.S., T.T., J.T., Y.K., M. Hayano, T. Kimura), and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan (Y.F., T. Kita); Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.); Division of Cardiology, Kurashiki Central Hospital, Okayama, Japan (K.K., K.M.); Division of Cardiology (K.A., M.N.) and Division of Cardiovascular Surgery (M. Hanyu), Kokura Memorial Hospital, Fukuoka, Japan; Division of Cardiology, Kyoto Medical Center, Kyoto, Japan (M.A.); Division of Cardiology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (H.N.); Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka City Japan (M.S.); Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Osaka, Japan (N.N.); and Division of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan (T. Komiya). 2. From the Department of Cardiovascular Medicine and Hypertension (A.T., S.H., M.O.), and Cardiovascular and Gastoroenterological Surgery, Advanced Therapeutics Cardiovascular and Respiratory Disorders (Y.I.), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Department of Cardiovascular Medicine (H.S., K.O., S.S., T.T., J.T., Y.K., M. Hayano, T. Kimura), and Department of Cardiovascular Surgery (R.S.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan (Y.F., T. Kita); Division of Cardiology, Tenri Hospital, Nara, Japan (Y.N.); Division of Cardiology, Kurashiki Central Hospital, Okayama, Japan (K.K., K.M.); Division of Cardiology (K.A., M.N.) and Division of Cardiovascular Surgery (M. Hanyu), Kokura Memorial Hospital, Fukuoka, Japan; Division of Cardiology, Kyoto Medical Center, Kyoto, Japan (M.A.); Division of Cardiology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (H.N.); Department of Cardiovascular Surgery, Iwate Medical University, Iwate, Japan (H.O.); Division of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka City Japan (M.S.); Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Osaka, Japan (N.N.); and Division of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan (T. Komiya). taketaka@kuhp.kyoto-u.ac.jp.
Abstract
BACKGROUND: Noncardiac surgery after percutaneous coronary intervention (PCI) has been reported to be carrying high risk for both ischemic and bleeding complications. However, there has been no report comparing the incidence and outcomes of surgical procedures after coronary artery bypass grafting (CABG) with those after PCI. METHODS AND RESULTS: Among 14 383 patients undergoing first coronary revascularization (PCI, n=12 207; CABG, n=2176) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG Registry Cohort-2, surgical procedures were performed more frequently after CABG (n=560) than after PCI (n=2398; cumulative 3-year incidence: 27% versus 22%; unadjusted P<0.0001), particularly <6 months of coronary revascularization. The risk for the primary ischemic outcome measure (death/myocardial infarction) at 30-day postsurgical procedures was not significantly different between the CABG and PCI groups (cumulative incidence: 3.1% versus 3.2%; unadjusted P=0.9; adjusted hazard ratio, 0.97; 95% confidence interval, 0.47-1.89; P=0.9). The risk for the primary bleeding outcome measure (moderate or severe bleeding by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries classification) was lower in the CABG groups than in the PCI group (cumulative incidence: 1.3% versus 2.6%; unadjusted P=0.07; adjusted hazard ratio, 0.36; 95% confidence interval, 0.12-0.87; P=0.02). There were no interactions between the timing of surgery and the types of coronary revascularization (CABG/PCI) for both ischemic and bleeding outcomes. CONCLUSIONS: Surgical procedures were performed significantly more frequently after CABG than after PCI, particularly <6 months after coronary revascularization. Surgical procedures after CABG as compared with those after PCI were associated with similar risk for ischemic events and lower risk for bleeding events, regardless of the timing after coronary revascularization.
BACKGROUND: Noncardiac surgery after percutaneous coronary intervention (PCI) has been reported to be carrying high risk for both ischemic and bleeding complications. However, there has been no report comparing the incidence and outcomes of surgical procedures after coronary artery bypass grafting (CABG) with those after PCI. METHODS AND RESULTS: Among 14 383 patients undergoing first coronary revascularization (PCI, n=12 207; CABG, n=2176) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG Registry Cohort-2, surgical procedures were performed more frequently after CABG (n=560) than after PCI (n=2398; cumulative 3-year incidence: 27% versus 22%; unadjusted P<0.0001), particularly <6 months of coronary revascularization. The risk for the primary ischemic outcome measure (death/myocardial infarction) at 30-day postsurgical procedures was not significantly different between the CABG and PCI groups (cumulative incidence: 3.1% versus 3.2%; unadjusted P=0.9; adjusted hazard ratio, 0.97; 95% confidence interval, 0.47-1.89; P=0.9). The risk for the primary bleeding outcome measure (moderate or severe bleeding by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries classification) was lower in the CABG groups than in the PCI group (cumulative incidence: 1.3% versus 2.6%; unadjusted P=0.07; adjusted hazard ratio, 0.36; 95% confidence interval, 0.12-0.87; P=0.02). There were no interactions between the timing of surgery and the types of coronary revascularization (CABG/PCI) for both ischemic and bleeding outcomes. CONCLUSIONS: Surgical procedures were performed significantly more frequently after CABG than after PCI, particularly <6 months after coronary revascularization. Surgical procedures after CABG as compared with those after PCI were associated with similar risk for ischemic events and lower risk for bleeding events, regardless of the timing after coronary revascularization.
Authors: Danielle Menosi Gualandro; Pai Ching Yu; Bruno Caramelli; André Coelho Marques; Daniela Calderaro; Luciana Savoy Fornari; Claudio Pinho; Alina Coutinho Rodrigues Feitosa; Carisi Anne Polanczyk; Carlos Eduardo Rochitte; Carlos Jardim; Carolina L Z Vieira; Debora Y M Nakamura; Denise Iezzi; Dirk Schreen; Eduardo Leal Adam; Elbio Antonio D'Amico; Emerson Q de Lima; Emmanuel de Almeida Burdmann; Enrique Indalecio Pachón Mateo; Fabiana Goulart Marcondes Braga; Fabio S Machado; Flavio J de Paula; Gabriel Assis Lopes do Carmo; Gilson Soares Feitosa-Filho; Gustavo Faibischew Prado; Heno Ferreira Lopes; João R C Fernandes; José J G de Lima; Luciana Sacilotto; Luciano Ferreira Drager; Luciano Janussi Vacanti; Luis Eduardo Paim Rohde; Luis F L Prada; Luis Henrique Wolff Gowdak; Marcelo Luiz Campos Vieira; Maristela Camargo Monachini; Milena Frota Macatrão-Costa; Milena Ribeiro Paixão; Mucio Tavares de Oliveira; Patricia Cury; Paula R Villaça; Pedro Silvio Farsky; Rinaldo F Siciliano; Roberto Henrique Heinisch; Rogerio Souza; Sandra F M Gualandro; Tarso Augusto Duenhas Accorsi; Wilson Mathias Journal: Arq Bras Cardiol Date: 2017 Jan-Feb Impact factor: 2.000
Authors: André Arpad Faludi; Maria Cristina de Oliveira Izar; José Francisco Kerr Saraiva; Ana Paula Marte Chacra; Henrique Tria Bianco; Abrahão Afiune; Adriana Bertolami; Alexandre C Pereira; Ana Maria Lottenberg; Andrei C Sposito; Antonio Carlos Palandri Chagas; Antonio Casella; Antônio Felipe Simão; Aristóteles Comte de Alencar; Bruno Caramelli; Carlos Costa Magalhães; Carlos Eduardo Negrão; Carlos Eduardo Dos Santos Ferreira; Carlos Scherr; Claudine Maria Alves Feio; Cristiane Kovacs; Daniel Branco de Araújo; Daniel Magnoni; Daniela Calderaro; Danielle Menosi Gualandro; Edgard Pessoa de Mello; Elizabeth Regina Giunco Alexandre; Emília Inoue Sato; Emilio Hideyuki Moriguchi; Fabiana Hanna Rached; Fábio César Dos Santos; Fernando Henpin Yue Cesena; Francisco Antonio Helfenstein Fonseca; Henrique Andrade Rodrigues da Fonseca; Hermes Toros Xavier; Isabela Cardoso Pimentel Mota; Isabela de Carlos Back Giuliano; Jaqueline Scholz Issa; Jayme Diament; João Bosco Pesquero; José Ernesto Dos Santos; José Rocha Faria; José Xavier de Melo; Juliana Tieko Kato; Kerginaldo Paulo Torres; Marcelo Chiara Bertolami; Marcelo Heitor Vieira Assad; Márcio Hiroshi Miname; Marileia Scartezini; Neusa Assumpta Forti; Otávio Rizzi Coelho; Raul Cavalcante Maranhão; Raul Dias Dos Santos; Renato Jorge Alves; Roberta Lara Cassani; Roberto Tadeu Barcellos Betti; Tales de Carvalho; Tânia Leme da Rocha Martinez; Viviane Zorzanelli Rocha Giraldez; Wilson Salgado Journal: Arq Bras Cardiol Date: 2017-07 Impact factor: 2.000