ORIGINAL ARTICLE Original Article The Impact of Prior Percutaneous Coronary Intervention on Long-Term Survival after Coronary Artery Bypass Grafting Wesley T. O’Neal, MD a,∗ , Jimmy T. Efird, PhD, MSc b,c , Curtis A. Anderson, MD b , Linda C. Kindell, RN b , Jason B. O’Neal, MD d , T. Bruce Ferguson, MD b , W. Randolph Chitwood, MD b and Alan P. Kypson, MD b a Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States b East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, United States c Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, United States d Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States Background: Previous studies examining the influence of prior percutaneous coronary intervention (PCI) on long- term survival after coronary artery bypass grafting (CABG) have reported conflicting results. The purpose of this study was to further examine the influence of prior PCI on long-term survival after CABG at a large tertiary referral heart institute. Methods: Long-term survival between 1992 and 2011 was compared in non-emergent CABG cases with and without prior PCI. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 2532 (19%) patients had prior PCI before CABG (n = 13,354). The median follow-up for study participants was 8.1 years. The median survival for patients with and without prior PCI was 15 years and 14 years, respectively (p < 0.0001). Long-term survival was similar between patients with and without prior PCI after adjusting for age, sex, race, hypertension, coronary artery disease severity, congestive heart failure, and prior stroke (adjusted HR = 0.99, 95%CI = 0.91–1.06). Conclusion: Findings from outcomes research are important in the planning of appropriate postoperative patient care. Our study provides additional evidence that prior PCI is not a significant predictor of long-term survival after CABG. (Heart, Lung and Circulation 2013;22:940–945) © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved. Keywords. PCI; CABG; Survival; Coronary artery disease Introduction T he need for repeat revascularisation in patients treated with percutaneous coronary intervention (PCI) has led to an increasing percentage of coronary artery bypass grafting (CABG) patients with prior PCI [1,2]. Prior PCI has been associated with increased in-hospital mortality following CABG [2–7]. However, studies examining the influence of prior PCI on long-term survival have reported conflicting results [3,8]. The purpose of this study was to Received 8 February 2013; accepted 15 April 2013; available online 14 May 2013 ∗ Corresponding author at: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States. Tel.: +1 919 288 4616. E-mail address: wesoneal85@gmail.com (W.T. O’Neal). further examine the impact of prior PCI on long-term sur- vival after CABG. Methods Study Design This was a retrospective cohort study of patients under- going first-time, isolated CABG at the East Carolina Heart Institute between 1992 and 2011. Demographic data, comorbid conditions, coronary artery disease (CAD) severity, and surgical data were collected at the time of surgery. Patients with prior PCI were compared with those without prior PCI. Only black and white patients were included to minimise the potential for residual confound- ing (∼1% other races). Racial identity was self-reported. Emergent cases were considered a clinically different © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved. 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2013.04.110