Impact of repeated percutaneous coronary intervention on long-term survival after subsequent coronary artery bypass surgery

Between January 1990 and January 2008, a total of 894 patients underwent first-time isolated elective CABG. Among the 894 patients, 515 patients had had no PCI (group A), 179 patients had had single PCI (Group B), and 200 patients had had multiple PCI (2-15 times, mean 3.6 ± 2.3 times) (group C) before CABG. These groups were compared in terms of early and late clinical results.Preoperative left ventricular ejection fraction was significantly higher in group A (group A;58 ± 13%, group B;54 ± 12%, and group C;54 ± 12%). Number of bypass grafts was significantly smaller in group C (A:3.3 ± 1.0, B 3.4 ± 0.9, C 3.1 ± 1.0). Although there was no statistically significant difference among the groups, in-hospital mortality in group C was higher than that in group A and B (A:1.6%, B:1.1%, C:3.5%, p = 0.16). Survival analysis by Kaplan-Meier method (mean follow-up: 58 ± 43 methods) revealed that freedom from all-cause death and cardiac death was significantly lower in group C in comparison with group A. Freedom from cardiac event was significantly higher in group C than that in group A. Multivariate analysis identified a number of previous PCI as an independent risk factor for cardiac death.Repeated PCI increased risk for long-term prognosis of subsequent CABG.Although clinical trials comparing PCI with percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease showed significant advantages with CABG in terms of the rate of repeat revascularization, major adverse cardiac event [1], and long-term survival [2,3] and the new ESC/EACTS guidelines on myocardial revascularization recommended CABG as the treatment of choice for patients with severe coronary artery disease [4], PCI has been increasingly used to treat complex coronary artery disease which had been thought to be a candidate for CABG as an initial treatment and aggressive repeated PCI with multiple stenting has been becoming more common in t