Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting

Fahad Alqahtani, Khaled M. Ziada, Vinay Badhwar, Gurpreet S Sandhu, Charanjit Rihal, Mohamad Alkhouli

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce. OBJECTIVES: The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG. Methods: This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses. Results: Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p < 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p < 0.001), acute kidney injury (16% vs. 12.3%; p < 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG. Conclusions: In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.

Original languageEnglish (US)
Pages (from-to)415-423
Number of pages9
JournalJournal of the American College of Cardiology
Volume73
Issue number4
DOIs
StatePublished - Feb 5 2019

Fingerprint

Percutaneous Coronary Intervention
Coronary Artery Bypass
Incidence
Ischemia
Hospital Mortality
Costs and Cost Analysis
Off-Pump Coronary Artery Bypass
Risk Adjustment
Mortality
Acute Kidney Injury
Inpatients
Length of Stay
Angiography
Hospitalization
Multivariate Analysis
Stroke
Regression Analysis

Keywords

  • coronary artery bypass grafting
  • graft failure
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting. / Alqahtani, Fahad; Ziada, Khaled M.; Badhwar, Vinay; Sandhu, Gurpreet S; Rihal, Charanjit; Alkhouli, Mohamad.

In: Journal of the American College of Cardiology, Vol. 73, No. 4, 05.02.2019, p. 415-423.

Research output: Contribution to journalArticle

Alqahtani, Fahad ; Ziada, Khaled M. ; Badhwar, Vinay ; Sandhu, Gurpreet S ; Rihal, Charanjit ; Alkhouli, Mohamad. / Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting. In: Journal of the American College of Cardiology. 2019 ; Vol. 73, No. 4. pp. 415-423.
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AU - Alqahtani, Fahad

AU - Ziada, Khaled M.

AU - Badhwar, Vinay

AU - Sandhu, Gurpreet S

AU - Rihal, Charanjit

AU - Alkhouli, Mohamad

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N2 - Background: Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce. OBJECTIVES: The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG. Methods: This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses. Results: Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p < 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p < 0.001), acute kidney injury (16% vs. 12.3%; p < 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG. Conclusions: In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.

AB - Background: Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce. OBJECTIVES: The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG. Methods: This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses. Results: Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p < 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p < 0.001), acute kidney injury (16% vs. 12.3%; p < 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG. Conclusions: In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.

KW - coronary artery bypass grafting

KW - graft failure

KW - percutaneous coronary intervention

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