European Heart Journal Advance Access originally published online on February 19, 2008
European Heart Journal 2008 29(5):673-679; doi:10.1093/eurheartj/ehn026
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Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization: insights from the imagine study
1 Department of Cardiac Surgery, Hopital Jean Minjoz, University of Franche-Comté, 25030 Besançon Cedex, France
2 Hôpital Laval, Laval University, Québec, Canada
3 Montreal Heart Institute, University of Montréal, Montréal, Canada
4 Foothills Hospital, University of Calgary, Calgary, Canada
5 AZ-VUB, Brussels, Belgium
6 Queen Elizabeth II Hospital, Dalhousie University, Halifax, Canada
7 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
8 Pfizer Canada Medical Division, Montréal, Canada
9 University of Groningen, Groningen, The Netherlands
Received 29 September 2007; revised 15 December 2007; accepted 10 January 2008; online publish-ahead-of-print 19 February 2008.
* Corresponding author. Tel: +33 3 81 66 86 64, Fax: +33 3 81 66 86 61, Email: sidney.chocron{at}univ-fcomte.fr. URL: http://www.chirurgie-cardiaque-besancon.org/
See page 573 for the editorial comment on this article (doi:10.1093/eurheartj/ehm645)
Aim: To determine the impact of previous coronary artery revascularization by percutaneous transluminal coronary angioplasty and/or stenting (PCI) on outcome after subsequent coronary artery bypass grafting (CABG).
Methods and results: The ischaemia management with Accupril post-bypass Graft via Inhibition of the coNverting Enzyme (IMAGINE) trial, conducted between November 1999 and September 2004, tested whether early initiation of an angiotensin-converting enzyme inhibitor post-CABG, in stable patients with LVEF 
40%, would reduce cardiovascular events. Of the 2489 patients included in the IMAGINE trial, undergoing their first operation, 430 had a history of PCI prior to surgery (PCI group), and 2059 were referred to surgery without previous PCI (non-PCI group). There was a significant increase in the primary IMAGINE endpoint in the PCI group, HR = 1.53 [1.17–1.98], P = 0.0016. Coronary revascularization, HR = 1.80 [1.13–2.87], P = 0.014, unstable angina requiring hospitalization, HR = 2.43 [1.52–3.89], P = 0.0002, were the two individual components that significantly increased in the PCI group, even when adjusted for baseline characteristics (age, sex, history of myocardial infarction or stroke, diabetes, treatment group, or off-pump surgery).
Conclusion: Patients with left ventricular ejection fraction 40% having a history of PCI prior to surgery had a worse outcome post-CABG than those with no prior PCI. Further studies are needed to investigate whether these results apply for drug eluting stents.
Key Words: Angioplasty • Transluminal • Percutaneous coronary • Coronary artery bypass
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  D. P. Taggart Does prior PCI increase the risk of subsequent CABG? Eur. Heart J., March 1, 2008; 29(5): 573 - 575. [Full Text] [PDF]
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