Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery
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 revascul...
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| Veröffentlicht in: | The Annals of thoracic surgery 2006-09, Vol.82 (3), p.795-801 |
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| creator | 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. |
| description | 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.
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.
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).
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. |
| doi_str_mv | 10.1016/j.athoracsur.2006.03.074 |
| format | Article |
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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.
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).
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.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2006.03.074</identifier><identifier>PMID: 16928485</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Angioplasty, Balloon, Coronary - statistics & numerical data ; Aortic Aneurysm, Abdominal - surgery ; Arterial Occlusive Diseases - surgery ; Coronary Artery Bypass - statistics & numerical data ; Elective Surgical Procedures ; Female ; Humans ; Incidence ; Intraoperative Complications - epidemiology ; Intraoperative Complications - prevention & control ; Leg - blood supply ; Leg - surgery ; Male ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Infarction - prevention & control ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Time Factors</subject><ispartof>The Annals of thoracic surgery, 2006-09, Vol.82 (3), p.795-801</ispartof><rights>2006 The Society of Thoracic Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-956134dcfda577664b283d36505f15492bd0a841b67ea0408134947eb97650223</citedby><cites>FETCH-LOGICAL-c407t-956134dcfda577664b283d36505f15492bd0a841b67ea0408134947eb97650223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16928485$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ward, Herbert B.</creatorcontrib><creatorcontrib>Kelly, Rosemary F.</creatorcontrib><creatorcontrib>Thottapurathu, Lizy</creatorcontrib><creatorcontrib>Moritz, Thomas E.</creatorcontrib><creatorcontrib>Larsen, Greg C.</creatorcontrib><creatorcontrib>Pierpont, Gordon</creatorcontrib><creatorcontrib>Santilli, Steve</creatorcontrib><creatorcontrib>Goldman, Steven</creatorcontrib><creatorcontrib>Krupski, William C.</creatorcontrib><creatorcontrib>Littooy, Fred</creatorcontrib><creatorcontrib>Reda, Domenic J.</creatorcontrib><creatorcontrib>McFalls, Edward O.</creatorcontrib><title>Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>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.
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.
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).
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.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary - statistics & numerical data</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Coronary Artery Bypass - statistics & numerical data</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intraoperative Complications - epidemiology</subject><subject>Intraoperative Complications - prevention & control</subject><subject>Leg - blood supply</subject><subject>Leg - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - prevention & control</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Time Factors</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EokvLX0A-cUtwEn8kx3aBUqlVK5VytRxnUrzKxsvYXmn_Er8SR7vQI6fReJ53PvwSQitWVqySnzaliT89GhsSljVjsmRNyRR_RVaVEHUha9G9JivGWFPwTokz8i6ETU7rXH5LzirZ1S1vxYr8Xnv0s8EDvcQIOVwddiYEeo1mjG5-pi7Qx7QDdB5p9PQB0KZoZvAp0H_amzlr9zBH52fqZvqA8Dfz46JxPrcw0e2B3h28NTg4M2XZaNAuWKCfEy7jHlMf4FfKYvrDBJsmg_kNn_NqF-TNaKYA70_xnDx9_fJ9_a24vb--WV_eFpYzFYtOyKrhgx0HI5SSkvd12wyNFEyMleBd3Q_MtLzqpQLDOGsz3XEFfacyU9fNOfl47LtDnzcJUW9dsDBNx6u1bFXLJBMZbI-gRR8Cwqh36Lb5P3TF9OKT3ugXn_Tik2aNzj5l6YfTjNRvYXgRnozJwNURgHzp3gHqYB3MFgaHYKMevPv_lD_DL628</recordid><startdate>20060901</startdate><enddate>20060901</enddate><creator>Ward, Herbert B.</creator><creator>Kelly, Rosemary F.</creator><creator>Thottapurathu, Lizy</creator><creator>Moritz, Thomas E.</creator><creator>Larsen, Greg C.</creator><creator>Pierpont, Gordon</creator><creator>Santilli, Steve</creator><creator>Goldman, Steven</creator><creator>Krupski, William C.</creator><creator>Littooy, Fred</creator><creator>Reda, Domenic J.</creator><creator>McFalls, Edward O.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060901</creationdate><title>Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-956134dcfda577664b283d36505f15492bd0a841b67ea0408134947eb97650223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary - statistics & numerical data</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Arterial Occlusive Diseases - surgery</topic><topic>Coronary Artery Bypass - statistics & numerical data</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intraoperative Complications - epidemiology</topic><topic>Intraoperative Complications - prevention & control</topic><topic>Leg - blood supply</topic><topic>Leg - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - prevention & control</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ward, Herbert B.</creatorcontrib><creatorcontrib>Kelly, Rosemary F.</creatorcontrib><creatorcontrib>Thottapurathu, Lizy</creatorcontrib><creatorcontrib>Moritz, Thomas E.</creatorcontrib><creatorcontrib>Larsen, Greg C.</creatorcontrib><creatorcontrib>Pierpont, Gordon</creatorcontrib><creatorcontrib>Santilli, Steve</creatorcontrib><creatorcontrib>Goldman, Steven</creatorcontrib><creatorcontrib>Krupski, William C.</creatorcontrib><creatorcontrib>Littooy, Fred</creatorcontrib><creatorcontrib>Reda, Domenic J.</creatorcontrib><creatorcontrib>McFalls, Edward O.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ward, Herbert B.</au><au>Kelly, Rosemary F.</au><au>Thottapurathu, Lizy</au><au>Moritz, Thomas E.</au><au>Larsen, Greg C.</au><au>Pierpont, Gordon</au><au>Santilli, Steve</au><au>Goldman, Steven</au><au>Krupski, William C.</au><au>Littooy, Fred</au><au>Reda, Domenic J.</au><au>McFalls, Edward O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2006-09-01</date><risdate>2006</risdate><volume>82</volume><issue>3</issue><spage>795</spage><epage>801</epage><pages>795-801</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>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.
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.
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).
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.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>16928485</pmid><doi>10.1016/j.athoracsur.2006.03.074</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Angioplasty, Balloon, Coronary - statistics & numerical data Aortic Aneurysm, Abdominal - surgery Arterial Occlusive Diseases - surgery Coronary Artery Bypass - statistics & numerical data Elective Surgical Procedures Female Humans Incidence Intraoperative Complications - epidemiology Intraoperative Complications - prevention & control Leg - blood supply Leg - surgery Male Middle Aged Myocardial Infarction - epidemiology Myocardial Infarction - prevention & control Postoperative Complications - epidemiology Postoperative Complications - prevention & control Time Factors |
| title | Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery |
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