PREVIOUS PCI: UNDERESTIMATED ADDITIVE RISK FACTOR IN OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

Background. The number of percutaneous coronary interventions (PCI) has been increasing during the last decade and cardiac interventionalists expanded PCI to multivessel disease even in high-risk patients. Consequently, a number of patients underwent previous PCI are referred to coronary artery bypass grafting (CABG) due to symptom recurrence and restenosis. This study analyzed the influence of previous PCI on outcome of patients finally referred to CABG. Methods. From January 2011 to January 2014, 648 consecutive off-pump CABG patients were enrolled: 502 patients do not have had previous PCI (group A) and 146 patients have had previous PCI with stenting (group B). Adverse cardiac events, need for inotropic drugs or mechanical support, intensive care (ICU) length of stay, serum creatinine levels were evaluated. Results. The 30-day mortality was 1.6% (8/502 patients) in group A and 5.4% (8/146 patients) in group B (p=0.01). Adverse cardiac events incidence occurred in 3.7% of patients (19/502) in group A versus 11.6% (17/146) in group B (p<0.001). Need for reoperation for bleeding was slightly higher in group B (3.4% vs 0.9%, p=0.08). Number of grafts and distal anastomoses, inotropic support and supraventricular arrhythmias incidence did not differ between groups. In group A 3.5% of patients (18/502) needed mechanical support versus 10.2% (15/146) in group B (p=0.002); postoperative renal disease (serum creatinine >2 mg/dL) occurred in 1.6% of patients (8/502) in group A and in 4.7% of patients (7/146) in group B (p=0.005). ICU length of stay was significantly higher in group B (52.4 ± 8.6 vs 63.3 ± 9.8 hours, p<0.001). Conclusions. Previous PCI was an additive risk factor in patients who underwent subsequent CABG. Our results demonstrated that PCI-group had an increased 30-day mortality and incidence of adverse cardiac events.