Unplanned PCI After CABG

Study Questions:

What are the incidence, predictors, and outcomes among patients needing unplanned, in-hospital percutaneous coronary interventions (PCIs) after coronary artery bypass grafting (CABG)?

Methods:

This is a retrospective analysis from the National Inpatient Sample (NIS) of patients undergoing CABG from 2003 to 2014. Outcomes were compared among patients who received unplanned in-hospital PCI versus those who did not undergo PCI. The primary endpoint was in-patient mortality and secondary endpoints included length of stay, cost, and major complications such as stroke, acute kidney injury, and infectious complications.

Results:

Over 550,000 patients were included in the analysis, of which 24,503 (4.4%) needed coronary angiography post-CABG and 14,323 underwent PCI. Patients undergoing PCI had increased unadjusted (5.1% vs. 2.7%; p < 0.001) and adjusted mortality, stroke, acute kidney injury, and infectious complications. Post-CABG PCI also was associated with increased length of stay and cost. Nonelective admission (odds ratio [OR], 3.45; 95% confidence interval [CI], 3.30-3.60; p < 0.001) and off-pump CABG (OR, 1.85; 95% CI, 1.78-1.92; p < 0.001) predicted risk of post-CABG PCI.

Conclusions:

Approximately 3% of patients undergoing CABG need unplanned, in-hospital PCI following CABG and this is associated with increased in-hospital morbidity, mortality, length of stay, and cost.

Perspective:

This study highlights the unfavorable risks associated with unplanned, in-hospital PCI post-CABG. Although not that common, based on the current analysis, unplanned PCI post-CABG portends increased morbidity and mortality. The authors attempted to adjust for the limitations of the NIS database by performing multiple model multivariate adjustments and sensitivity analysis. Limitations remain, including inability to prove the acute or unplanned nature of PCI and reporting bias inherent to the database.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Kidney Injury, Cardiac Surgical Procedures, Coronary Angiography, Coronary Artery Bypass, Hospital Mortality, Infection, Length of Stay, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Stroke, Vascular Diseases


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