Ueki Chikara, Miyata Hiroaki, Motomura Noboru, Sakaguchi Genichi, Akimoto Takehide, Takamoto Shinichi
Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan; Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
Ann Thorac Surg. 2017 Jul;104(1):56-61. doi: 10.1016/j.athoracsur.2016.10.028. Epub 2017 Jan 25.
Adverse effects of previous percutaneous coronary intervention (PCI) on clinical outcomes after coronary artery bypass grafting (CABG) are unclear. This study aimed to evaluate the effect of previous PCI on early outcomes after subsequent CABG by using data from the Japanese national database.
This study analyzed data from 48,051 consecutive patients that were retrieved from the Japan Adult Cardiovascular Surgery Database. These patients underwent primary, isolated, elective CABG between January 2008 and December 2013. Early mortality and morbidity rates in patients with previous PCI (n = 12,457, 25.9%) were compared with those in patients with no PCI (n = 35,594, 74.1%) by using multivariate logistic regression analysis and propensity score analysis.
Operative mortality rates (no PCI, 1.2%; previous PCI, 1.2%; P = 0.970) and morbidity rates (no PCI, 7.4%; previous PCI, 7.2%; p = 0.436) were similar between the two groups. In risk-adjusted multivariate logistic-regression analysis, previous PCI (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.82 to 1.22; p = 0.995) and morbidity (OR, 0.97; 95% CI, 0.89 to 1.05; p = 0.391) were not significant risk factors of operative mortality. Inverse probability of treatment weighting using the propensity score confirmed these results.
This study shows that a previous PCI procedure does not increase postoperative adverse events after subsequent CABG. In the setting of repeat coronary revascularization, the most appropriate method of revascularization should be selected by the heart team, without being affected by a history of a previous PCI procedure.
既往经皮冠状动脉介入治疗（PCI）对冠状动脉旁路移植术（CABG）后临床结局的不良影响尚不清楚。本研究旨在利用日本国家数据库的数据评估既往PCI对后续CABG术后早期结局的影响。
本研究分析了从日本成人心血管外科数据库中检索出的48051例连续患者的数据。这些患者在2008年1月至2013年12月期间接受了初次、单纯、择期CABG。采用多因素logistic回归分析和倾向评分分析，比较既往接受PCI治疗的患者（n = 12457，25.9%）和未接受PCI治疗的患者（n = 35594，74.1%）的早期死亡率和发病率。
两组的手术死亡率（未接受PCI治疗组为1.2%；既往接受PCI治疗组为1.2%；P = 0.970）和发病率（未接受PCI治疗组为7.4%；既往接受PCI治疗组为7.2%；P = 0.436）相似。在风险调整的多因素logistic回归分析中，既往PCI治疗（比值比[OR]，1.00；95%置信区间[CI]，0.82至1.22；P = 0.995）和发病率（OR，0.97；95%CI，0.89至1.05；P = 0.391）不是手术死亡率的显著危险因素。使用倾向评分进行的治疗权重逆概率分析证实了这些结果。
本研究表明，既往PCI手术不会增加后续CABG术后的不良事件。在重复冠状动脉血运重建的情况下，心脏团队应选择最合适的血运重建方法，而不受既往PCI手术史的影响。
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