ArticleInterdisciplinary cardiovascular and thoracic surgery2025
Anatomical burden of prior percutaneous coronary intervention and long-term outcomes after coronary artery bypass grafting: An analysis spanning two decades.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to determine whether the anatomical burden of prior percutaneous coronary intervention(PCI) influences long-term outcomes after coronary artery bypass grafting, beyond the impact of intervention presence alone.
methodsThis retrospective study analyzed consecutive patients undergoing coronary artery bypass grafting at a single institution between 2000 and 2024. The inclusion criteria comprised isolated, non-emergent surgery. Patient categorization was based on prior PCI-treated lesions: none, single, or multiple. The primary endpoint was long-term overall survival. The secondary endpoints included cardiac death, myocardial infarction, stroke, heart failure hospitalization, and repeat revascularization. Long-term outcomes were assessed using Kaplan-Meier analysis and Cox multivariable models, adjusting for 26 clinical factors.
resultsOf 2,442 patients, 1,205 met the inclusion criteria (755 none, 227 single-lesion, 223 multiple-lesion intervention). Over a median follow-up of 12.0 (interquartile range, 11.3-12.9; maximum: 24.2) years, the multiple-lesion intervention group had higher rates of in-hospital acute kidney injury (34.1% vs. 21.1% vs. 24.2%, P = 0.003). Overall survival differed significantly between groups over the follow-up period (log-rank P = 0.004), with 15-year survival rates of 35.8%, 46.0%, and 48.0% for multiple-lesion, single-lesion, and no prior PCI groups, respectively. After adjustment, multiple-lesion intervention was associated with increased risks of cardiac death (adjusted subdistribution hazard ratio: 1.91), myocardial infarction (2.26), and repeat revascularization (1.92) compared with no prior intervention.
conclusionsMultiple-lesion PCI was associated with higher long-term risks of cardiac death, myocardial infarction, and repeat revascularization, while stroke risk was similar. Single-lesion PCI showed outcomes comparable to no prior PCI except for higher heart failure hospitalization. These findings require confirmation in larger, multicenter comparative studies to address residual confounding.
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