Fahad Alqahtani1, Khaled M Ziada2, Vinay Badhwar1, Gurpreet Sandhu3, Charanjit S Rihal3, Mohamad Alkhouli4. 1. West Virginia University Heart and Vascular Institute, Morgantown, West Virginia. 2. Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky. 3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 4. West Virginia University Heart and Vascular Institute, Morgantown, West Virginia. Electronic address: Mohamad.Alkhouli@wvumedicine.org.
Abstract
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.
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.
Authors: Frans J Beerkens; Bimmer E Claessen; Marielle Mahan; Mario F L Gaudino; Derrick Y Tam; José P S Henriques; Roxana Mehran; George D Dangas Journal: Nat Rev Cardiol Date: 2021-10-05 Impact factor: 32.419