Giovanni Mariscalco1, Stefano Rosato2, Giuseppe F Serraino2, Daniele Maselli2, Magnus Dalén2, Juhani K E Airaksinen2, Daniel Reichart2, Marco Zanobini2, Francesco Onorati2, Marisa De Feo2, Riccardo Gherli2, Giuseppe Santarpino2, Antonino S Rubino2, Giuseppe Gatti2, Francesco Nicolini2, Francesco Santini2, Andrea Perrotti2, Vito D Bruno2, Vito G Ruggieri2, Fausto Biancari2. 1. From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and Anesthesiology (M.D.), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Heart Center, Turku University Hospital (J.K.E.A., F.B.) and Department of Surgery (F.B.), University of Turku, Finland; Hamburg University Heart Center, Germany (D.R.); Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Italy (M.Z.); Division of Cardiovascular Surgery, Verona University Hospital, Italy (F.O.); Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Italy (M.D.F.); Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy (R.G.); Città di Lecce Hospital, GVM Care and Research, Italy (G.S.); Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany (G.S.); Centro Clinico Diagnostico G.B. Morgagni, Centro Cuore, Pedara, Italy (A.S.R.); Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy (G.G.); Division of Cardiac Surgery, University of Parma, Italy (F.N.); Division of Cardiac Surgery, University of Genoa, Italy (F.S.); Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France (A.P.); Heart Centre, Bristol University, United Kingdom (V.D.B.); Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France (V.G.R.); and Department of Surgery, Oulu University Hospital, Finland (F.B.). giovannimariscalco@yahoo.it. 2. From the Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, United Kingdom (G.M., G.F.S.); National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy (S.R.); Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Italy (G.F.S.); Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy (D.M.); Department of Molecular Medicine and Surgery (M.D.) and Department of Cardiothoracic Surgery and Anesthesiology (M.D.), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Heart Center, Turku University Hospital (J.K.E.A., F.B.) and Department of Surgery (F.B.), University of Turku, Finland; Hamburg University Heart Center, Germany (D.R.); Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Italy (M.Z.); Division of Cardiovascular Surgery, Verona University Hospital, Italy (F.O.); Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Italy (M.D.F.); Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy (R.G.); Città di Lecce Hospital, GVM Care and Research, Italy (G.S.); Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany (G.S.); Centro Clinico Diagnostico G.B. Morgagni, Centro Cuore, Pedara, Italy (A.S.R.); Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy (G.G.); Division of Cardiac Surgery, University of Parma, Italy (F.N.); Division of Cardiac Surgery, University of Genoa, Italy (F.S.); Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France (A.P.); Heart Centre, Bristol University, United Kingdom (V.D.B.); Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France (V.G.R.); and Department of Surgery, Oulu University Hospital, Finland (F.B.).
Abstract
BACKGROUND: The clinical impact of prior percutaneous coronary intervention (PCI) in patients requiring coronary artery bypass grafting (CABG) remains unsettled. We sought to determine whether prior PCI is associated with adverse outcome after CABG. METHODS AND RESULTS: Data from the prospective E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and March 2016 at 16 European centres were analyzed using propensity weighted methodology to adjust for confounding. A parallel systematic review/meta-analysis (MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was accomplished. Of a total of 3641 adult patients included in the E-CABG study, 685 (19%) patients had a history of PCI. At multivariable level, prior PCI was not associated with an increased hospital mortality in both unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence interval, 0.29-1.38; P=0.33 and odds ratio, 0.90; 95% confidence interval, 0.39-2.08; P=0.81, respectively). Subgroup analyses confirmed that prior PCI had no impact on hospital mortality and morbidity, including reexploration for bleeding, blood transfusion, hospital resource use, and neurological, renal, and cardiac complications. The systematic review provided a total of 71 366 individuals and showed a trend toward higher in-hospital/30-day mortality (adjusted odds ratio, 1.30; 95% confidence interval, 0.99-1.70; I2=43.1%) in patients with prior PCI. CONCLUSIONS: Our prospective multicenter study showed that prior PCI was not associated with an increased risk of mortality or other adverse outcomes in patients undergoing CABG. In light of a trend toward increased mortality observed in the meta-analysis, further studies are needed to ascertain the prognostic impact of prior PCI in the outcome after CABG. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02319083.
BACKGROUND: The clinical impact of prior percutaneous coronary intervention (PCI) in patients requiring coronary artery bypass grafting (CABG) remains unsettled. We sought to determine whether prior PCI is associated with adverse outcome after CABG. METHODS AND RESULTS: Data from the prospective E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and March 2016 at 16 European centres were analyzed using propensity weighted methodology to adjust for confounding. A parallel systematic review/meta-analysis (MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was accomplished. Of a total of 3641 adult patients included in the E-CABG study, 685 (19%) patients had a history of PCI. At multivariable level, prior PCI was not associated with an increased hospital mortality in both unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence interval, 0.29-1.38; P=0.33 and odds ratio, 0.90; 95% confidence interval, 0.39-2.08; P=0.81, respectively). Subgroup analyses confirmed that prior PCI had no impact on hospital mortality and morbidity, including reexploration for bleeding, blood transfusion, hospital resource use, and neurological, renal, and cardiac complications. The systematic review provided a total of 71 366 individuals and showed a trend toward higher in-hospital/30-day mortality (adjusted odds ratio, 1.30; 95% confidence interval, 0.99-1.70; I2=43.1%) in patients with prior PCI. CONCLUSIONS: Our prospective multicenter study showed that prior PCI was not associated with an increased risk of mortality or other adverse outcomes in patients undergoing CABG. In light of a trend toward increased mortality observed in the meta-analysis, further studies are needed to ascertain the prognostic impact of prior PCI in the outcome after CABG. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02319083.
Authors: Jose C Nicolau; Susanna R Stevens; Hussein R Al-Khalidi; Fabio B Jatene; Remo H M Furtado; Luis A O Dallan; Luiz A F Lisboa; Patrice Desvigne-Nickens; Haissam Haddad; E Marc Jolicoeur; Mark C Petrie; Torsten Doenst; Robert E Michler; E Magnus Ohman; Jyotsna Maddury; Imtiaz Ali; Marek A Deja; Jean L Rouleau; Eric J Velazquez; James A Hill Journal: Int J Cardiol Date: 2019-03-15 Impact factor: 4.164
Authors: Fausto Biancari; Magnus Dalén; Vito G Ruggieri; Till Demal; Giuseppe Gatti; Francesco Onorati; Giuseppe Faggian; Antonino S Rubino; Daniele Maselli; Riccardo Gherli; Antonio Salsano; Matteo Saccocci; Giuseppe Santarpino; Francesco Nicolini; Tuomas Tauriainen; Marisa De Feo; Juhani Airaksinen; Stefano Rosato; Andrea Perrotti; Giovanni Mariscalco Journal: J Am Heart Assoc Date: 2018-10-16 Impact factor: 5.501