Comparison of clinical outcomes among patients undergoing cabg with or without prior PCI

IntroductionThere are increasing numbers of patients who are referred for coronary artery bypass grafting (CABG) after prior percutaneous coronary intervention (PCI) due to in stent thrombosis or other coronary complications. The intent here is to characterize the risk, if any, that is associated with a prior PCI experience.ObjectivesTo compare clinical outcomes between patients undergoing CABG with or without previous PCI.MethodsThis is a retrospective chart review study. Two hundred seventy eight patients underwent CABG at KING FAHAD MEDICAL CITY, KSA between January 2009 to December 2010, of whom, 60 patients had prior PCI and 218 without a previous PCI. Primary outcome measures included post CABG survival, hospital stay, post CABG inraaortic balloon, myocardial infarction, or repeat revascularization. Statistical analysis was pursed using the t-test /Wilcoxon and multiple linear regression analysis test for the continuous outcomes and the chi-square/Fisher exact test and logistic regression analysis for dichotomous outcomes. SAS version 9.3; Carey, NC, USA was used for statistical analysis.ResultsOverall there were 278 patients (60 in the CABG plus prior PCI group and 218 in the CABG alone group). All patients were followed up to 2 year post-CABG. All pre-CABG demographic and clinical characteristics were similar between the two groups. Overall, mean age was 59.3 years (median=59 years); 54 (20%) females and both age and gender distributions were similar between the two groups. Mortality in the CABG alone group occurred in 6/218 patients (2.8%) compared to 2/60 (3.3%) in the CABG with prior PCI group (p=0.8). Sixty six (30.3%) on the CABG alone group had recent MI vs. 29/60 (49.2%) in the CABG with prior PCI, p value=0.007. Mean+sd of hospital stay was 11.8+12 days on the CABG alone group vs. 13.7+11.6 days on the CABG with prior PCI group, p-value=0.27. Postoperative need of inraaortic balloon occurred among 7 (11.62%) cases in the CABG alone group and among 3 cases (5.5%) in the CABG with prior PCI group, p value=0.33.ConclusionsAlthough the incidence of recent MI differed significantly between the two groups, no apparent differences were detected in terms of mortality, hospital stay and need for inraaortic balloon. Prospective studies as well increasing the sample size and extended follow-up are further required to validate the results