Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery

Herbert B. Ward, Rosemary F. Kelly, Lizy Thottapurathu, Thomas E. Moritz, Greg C. Larsen, Gordon Pierpont, Steve Santilli, Steven Goldman, William C. Krupski, Fred Littooy, Domenic J. Reda, Edward O. McFalls

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Among patients in need of coronary revascularization before an elective vascular operation, the value of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in preventing perioperative myocardial infarctions is uncertain. We hypothesized that more complete revascularization would improve outcomes after vascular surgery. Methods: In this Veterans Affairs Cooperative trial involving 18 medical centers, 222 patients underwent elective vascular surgery after coronary revascularization. The mode of coronary revascularization was selected at each site by the local investigators (CABG in 91 patients and PCI in 131 patients). The vascular surgical indications were similar in both groups. Results: There were 2 deaths in the CABG group (2.2%) and 5 deaths in the PCI group (3.8%; p = 0.497) after the vascular procedure. There were fewer perioperative myocardial infarctions after the vascular operation in CABG patients (6.6%) than in PCI patients (16.8%; p = 0.024), despite more diseased vessels in the CABG group (3.0 ± 1.3 versus 2.2 ± 1.4, respectively; p < 0.001). The completeness of revascularization (defined as the number of coronary artery vessels revascularized relative to the total number of vessels with a stenosis ≥70%) in patients in the CABG and PCI groups was 117% ± 63% and 81% ± 57%, respectively (p < 0.001). Hospital length of stay in CABG versus PCI patients was 6 (4, 8) and 7 (4, 10) days, respectively (p = 0.078). Conclusions: Among patients receiving multivessel coronary artery revascularization as prophylaxis for elective vascular surgery, patients having a CABG had fewer myocardial infarctions and tended to spend less time in the hospital after the vascular operation than patients having a PCI. More complete revascularization accounted for the intergroup differences.

Original languageEnglish (US)
Pages (from-to)795-801
Number of pages7
JournalAnnals of Thoracic Surgery
Volume82
Issue number3
DOIs
StatePublished - Sep 2006
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Coronary Artery Bypass
Blood Vessels
Myocardial Infarction
Coronary Vessels
Length of Stay
Veterans
Pathologic Constriction
Research Personnel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery. / Ward, Herbert B.; Kelly, Rosemary F.; Thottapurathu, Lizy; Moritz, Thomas E.; Larsen, Greg C.; Pierpont, Gordon; Santilli, Steve; Goldman, Steven; Krupski, William C.; Littooy, Fred; Reda, Domenic J.; McFalls, Edward O.

In: Annals of Thoracic Surgery, Vol. 82, No. 3, 09.2006, p. 795-801.

Research output: Contribution to journalArticle

Ward, HB, Kelly, RF, Thottapurathu, L, Moritz, TE, Larsen, GC, Pierpont, G, Santilli, S, Goldman, S, Krupski, WC, Littooy, F, Reda, DJ & McFalls, EO 2006, 'Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery', Annals of Thoracic Surgery, vol. 82, no. 3, pp. 795-801. https://doi.org/10.1016/j.athoracsur.2006.03.074
Ward, Herbert B. ; Kelly, Rosemary F. ; Thottapurathu, Lizy ; Moritz, Thomas E. ; Larsen, Greg C. ; Pierpont, Gordon ; Santilli, Steve ; Goldman, Steven ; Krupski, William C. ; Littooy, Fred ; Reda, Domenic J. ; McFalls, Edward O. / Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 3. pp. 795-801.
@article{ece9a913a39c41dd9585da28d815df2e,
title = "Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery",
abstract = "Background: Among patients in need of coronary revascularization before an elective vascular operation, the value of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in preventing perioperative myocardial infarctions is uncertain. We hypothesized that more complete revascularization would improve outcomes after vascular surgery. Methods: In this Veterans Affairs Cooperative trial involving 18 medical centers, 222 patients underwent elective vascular surgery after coronary revascularization. The mode of coronary revascularization was selected at each site by the local investigators (CABG in 91 patients and PCI in 131 patients). The vascular surgical indications were similar in both groups. Results: There were 2 deaths in the CABG group (2.2{\%}) and 5 deaths in the PCI group (3.8{\%}; p = 0.497) after the vascular procedure. There were fewer perioperative myocardial infarctions after the vascular operation in CABG patients (6.6{\%}) than in PCI patients (16.8{\%}; p = 0.024), despite more diseased vessels in the CABG group (3.0 ± 1.3 versus 2.2 ± 1.4, respectively; p < 0.001). The completeness of revascularization (defined as the number of coronary artery vessels revascularized relative to the total number of vessels with a stenosis ≥70{\%}) in patients in the CABG and PCI groups was 117{\%} ± 63{\%} and 81{\%} ± 57{\%}, respectively (p < 0.001). Hospital length of stay in CABG versus PCI patients was 6 (4, 8) and 7 (4, 10) days, respectively (p = 0.078). Conclusions: Among patients receiving multivessel coronary artery revascularization as prophylaxis for elective vascular surgery, patients having a CABG had fewer myocardial infarctions and tended to spend less time in the hospital after the vascular operation than patients having a PCI. More complete revascularization accounted for the intergroup differences.",
author = "Ward, {Herbert B.} and Kelly, {Rosemary F.} and Lizy Thottapurathu and Moritz, {Thomas E.} and Larsen, {Greg C.} and Gordon Pierpont and Steve Santilli and Steven Goldman and Krupski, {William C.} and Fred Littooy and Reda, {Domenic J.} and McFalls, {Edward O.}",
year = "2006",
month = "9",
doi = "10.1016/j.athoracsur.2006.03.074",
language = "English (US)",
volume = "82",
pages = "795--801",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery

AU - Ward, Herbert B.

AU - Kelly, Rosemary F.

AU - Thottapurathu, Lizy

AU - Moritz, Thomas E.

AU - Larsen, Greg C.

AU - Pierpont, Gordon

AU - Santilli, Steve

AU - Goldman, Steven

AU - Krupski, William C.

AU - Littooy, Fred

AU - Reda, Domenic J.

AU - McFalls, Edward O.

PY - 2006/9

Y1 - 2006/9

N2 - Background: Among patients in need of coronary revascularization before an elective vascular operation, the value of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in preventing perioperative myocardial infarctions is uncertain. We hypothesized that more complete revascularization would improve outcomes after vascular surgery. Methods: In this Veterans Affairs Cooperative trial involving 18 medical centers, 222 patients underwent elective vascular surgery after coronary revascularization. The mode of coronary revascularization was selected at each site by the local investigators (CABG in 91 patients and PCI in 131 patients). The vascular surgical indications were similar in both groups. Results: There were 2 deaths in the CABG group (2.2%) and 5 deaths in the PCI group (3.8%; p = 0.497) after the vascular procedure. There were fewer perioperative myocardial infarctions after the vascular operation in CABG patients (6.6%) than in PCI patients (16.8%; p = 0.024), despite more diseased vessels in the CABG group (3.0 ± 1.3 versus 2.2 ± 1.4, respectively; p < 0.001). The completeness of revascularization (defined as the number of coronary artery vessels revascularized relative to the total number of vessels with a stenosis ≥70%) in patients in the CABG and PCI groups was 117% ± 63% and 81% ± 57%, respectively (p < 0.001). Hospital length of stay in CABG versus PCI patients was 6 (4, 8) and 7 (4, 10) days, respectively (p = 0.078). Conclusions: Among patients receiving multivessel coronary artery revascularization as prophylaxis for elective vascular surgery, patients having a CABG had fewer myocardial infarctions and tended to spend less time in the hospital after the vascular operation than patients having a PCI. More complete revascularization accounted for the intergroup differences.

AB - Background: Among patients in need of coronary revascularization before an elective vascular operation, the value of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in preventing perioperative myocardial infarctions is uncertain. We hypothesized that more complete revascularization would improve outcomes after vascular surgery. Methods: In this Veterans Affairs Cooperative trial involving 18 medical centers, 222 patients underwent elective vascular surgery after coronary revascularization. The mode of coronary revascularization was selected at each site by the local investigators (CABG in 91 patients and PCI in 131 patients). The vascular surgical indications were similar in both groups. Results: There were 2 deaths in the CABG group (2.2%) and 5 deaths in the PCI group (3.8%; p = 0.497) after the vascular procedure. There were fewer perioperative myocardial infarctions after the vascular operation in CABG patients (6.6%) than in PCI patients (16.8%; p = 0.024), despite more diseased vessels in the CABG group (3.0 ± 1.3 versus 2.2 ± 1.4, respectively; p < 0.001). The completeness of revascularization (defined as the number of coronary artery vessels revascularized relative to the total number of vessels with a stenosis ≥70%) in patients in the CABG and PCI groups was 117% ± 63% and 81% ± 57%, respectively (p < 0.001). Hospital length of stay in CABG versus PCI patients was 6 (4, 8) and 7 (4, 10) days, respectively (p = 0.078). Conclusions: Among patients receiving multivessel coronary artery revascularization as prophylaxis for elective vascular surgery, patients having a CABG had fewer myocardial infarctions and tended to spend less time in the hospital after the vascular operation than patients having a PCI. More complete revascularization accounted for the intergroup differences.

UR - http://www.scopus.com/inward/record.url?scp=33747341866&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33747341866&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2006.03.074

DO - 10.1016/j.athoracsur.2006.03.074

M3 - Article

C2 - 16928485

AN - SCOPUS:33747341866

VL - 82

SP - 795

EP - 801

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 3

ER -