Does prior percutaneous coronary revascularization negatively affect the outcomes of subsequent coronary artery bypass grafting?

Background: The growing use of percutaneous coronary intervention (PCI) has led to an increasing number of patients referred for coronary artery bypass grafting (CABG) after prior PCI. The impact of previous PCI on CABG outcomes remains controversial, and the prognostic significance of PCI burden has not been fully clarified. This study evaluated the effect of prior PCI on outcomes after CABG. Methods: Consecutive patients undergoing elective isolated CABG at six high-volume centers between 2018 and 2022 were analyzed. Patients were stratified according to PCI history into no prior PCI, single prior PCI, or multiple prior PCI. Early postoperative outcomes and 1- and 3-year follow-up events were assessed. The primary endpoint was midterm all-cause mortality. Results: A total of 2,823 patients were included. Baseline characteristics were comparable among groups. Patients with multiple prior PCI more frequently required coronary endarterectomy and grafting of small-caliber target vessels. Early mortality was similar across groups, while perioperative myocardial infarction was more frequent in patients with multiple prior PCI (2.9% vs 0.9% vs 0.6%; p=0.015). During follow-up, prior PCI-particularly multiple procedures-was associated with higher rates of myocardial infarction, stroke, and repeat revascularization, whereas midterm survival was similar. Conclusions: Prior PCI was not associated with increased early or midterm mortality after elective isolated CABG. However, multiple prior PCIs were associated with higher perioperative myocardial infarction and adverse cardiovascular events during follow-up, suggesting that PCI burden should be considered in preoperative risk stratification and Heart Team decision-making.