Copyright © 2002 by the European Society of Cardiology.
Effect of prior revascularization on outcome following percutaneous coronary intervention. NHLBI Dynamic Registry
a Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
b Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, U.S.A.
revised April 2, 2002; accepted April 10, 2002
Abstract
Aims An increasing number of patients undergoing percutaneous coronary intervention (PCI) have experienced previous revascularization procedures. Their outcome after PCI has seldom been compared to that of patients without prior procedures. This study investigates which elements of prior revascularization affect in-hospital and long-term outcome after PCI.
Methods and Results Baseline characteristics as well as in-hospital and 1-year outcomes were compared in 4010 consecutive patients undergoing PCI in the NHLBI Dynamic Registry, categorized by type of prior procedure. In-hospital mortality was lowest and procedural success highest among patients with prior PCI only. Patients with prior coronary artery bypass grafting (CABG) had higher rates for the combined endpoint of death and myocardial infarction (MI) at 1 year compared to patients with no prior procedures. However, in multivariate regression analysis adjusting for potential confounders, neither prior PCI nor prior CABG were independent predictors of death or death/MI at 1 year. Patients with prior procedure had higher rates for repeat PCI and patients with prior PCI had higher rates for CABG during the year following the index procedures. These associations persisted after adjustment for potential confounders. Finally, patients with prior procedures had a higher prevalence of angina at 1 year.
Conclusions Due to adverse baseline characteristics, patients with prior CABG have higher rates for death/MI during the first year after PCI and both groups of patients with prior procedures have higher revascularization rates. However, only the associations with repeat revascularization persist after adjustment for baseline and procedural factors.
Key Words: Registry, percutaneous coronary intervention, coronary bypass surgery, death or myocardial infarction, angina, repeat revascularization
f1 Correspondence: Dr Katherine M. Detre, DrPH, NHLBI Dynamic Registry, Data Coordinating Center, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, 127 Parran Hall, Pittsburgh, PA 15261, U.S.A.
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