The impact of preoperative thrombolysis on long-term survival after coronary artery bypass grafting

Ioannis K. Toumpoulis, Constantine E. Anagnostopoulos, Demosthenes G. Katritsis, Joseph DeRose, Daniel G. Swistel

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background - Coronary artery bypass grafting (CABG) is frequently used after thrombolytic therapy. However, there is little information regarding long-term survival in this setting. The purpose of the present study was to compare the long-term survival of patients subjected to CABG after thrombolysis to those without thrombolysis. Methods and Results - We studied 3760 consecutive patients with isolated CABG between 1992 and 2002. CABG patients without thrombolysis were compared with those who were treated with thrombolysis within 7 days before CABG. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for thrombolysis was determined by logistic regression analysis, and each patient with thrombolysis was then matched to 5 patients without thrombolysis. One hundred ninety-six patients (5.2%) were treated with thrombolysis. Patients with thrombolysis were more likely to be male, younger, and with higher rates of unstable angina, emergency operation, recent or transmural myocardial infarction, preoperative intraaortic balloon pump, hemodynamic instability, shock, intravenous nitroglycerine, left-ventricular hypertrophy, sustained ventricular arrhythmia, and higher EuroSCORE. There were no differences in early outcome between matched groups, but the 5-year actuarial survival was higher in patients with thrombolysis (90.3±2.2% versus 78.5±1.6%; P=0.0007). After adjustment for all factors, the hazard ratio of long-term mortality for patients with thrombolysis was 0.54 (95% CI, 0.36 to 0.81; P=0.003) and, if deaths during the first 12 months were excluded, 0.46 (95% CI, 0.27 to 0.76; P=0.003). Conclusions - Patients subjected to CABG within 7 days after thrombolysis demonstrated increased long-term survival.

Original languageEnglish (US)
JournalCirculation
Volume112
Issue number9 SUPPL.
DOIs
StatePublished - Aug 30 2005
Externally publishedYes

Fingerprint

Coronary Artery Bypass
Survival
Thrombolytic Therapy
Unstable Angina
Nitroglycerin
Left Ventricular Hypertrophy
Proportional Hazards Models
Cardiac Arrhythmias
Shock
Emergencies
Research Design
Logistic Models
Hemodynamics
Myocardial Infarction
Regression Analysis
Mortality

Keywords

  • Coronary artery bypass grafting
  • Long-term mortality
  • Thrombolysis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

The impact of preoperative thrombolysis on long-term survival after coronary artery bypass grafting. / Toumpoulis, Ioannis K.; Anagnostopoulos, Constantine E.; Katritsis, Demosthenes G.; DeRose, Joseph; Swistel, Daniel G.

In: Circulation, Vol. 112, No. 9 SUPPL., 30.08.2005.

Research output: Contribution to journalArticle

Toumpoulis, Ioannis K. ; Anagnostopoulos, Constantine E. ; Katritsis, Demosthenes G. ; DeRose, Joseph ; Swistel, Daniel G. / The impact of preoperative thrombolysis on long-term survival after coronary artery bypass grafting. In: Circulation. 2005 ; Vol. 112, No. 9 SUPPL.
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abstract = "Background - Coronary artery bypass grafting (CABG) is frequently used after thrombolytic therapy. However, there is little information regarding long-term survival in this setting. The purpose of the present study was to compare the long-term survival of patients subjected to CABG after thrombolysis to those without thrombolysis. Methods and Results - We studied 3760 consecutive patients with isolated CABG between 1992 and 2002. CABG patients without thrombolysis were compared with those who were treated with thrombolysis within 7 days before CABG. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for thrombolysis was determined by logistic regression analysis, and each patient with thrombolysis was then matched to 5 patients without thrombolysis. One hundred ninety-six patients (5.2{\%}) were treated with thrombolysis. Patients with thrombolysis were more likely to be male, younger, and with higher rates of unstable angina, emergency operation, recent or transmural myocardial infarction, preoperative intraaortic balloon pump, hemodynamic instability, shock, intravenous nitroglycerine, left-ventricular hypertrophy, sustained ventricular arrhythmia, and higher EuroSCORE. There were no differences in early outcome between matched groups, but the 5-year actuarial survival was higher in patients with thrombolysis (90.3±2.2{\%} versus 78.5±1.6{\%}; P=0.0007). After adjustment for all factors, the hazard ratio of long-term mortality for patients with thrombolysis was 0.54 (95{\%} CI, 0.36 to 0.81; P=0.003) and, if deaths during the first 12 months were excluded, 0.46 (95{\%} CI, 0.27 to 0.76; P=0.003). Conclusions - Patients subjected to CABG within 7 days after thrombolysis demonstrated increased long-term survival.",
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AU - Toumpoulis, Ioannis K.

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AU - Katritsis, Demosthenes G.

AU - DeRose, Joseph

AU - Swistel, Daniel G.

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AB - Background - Coronary artery bypass grafting (CABG) is frequently used after thrombolytic therapy. However, there is little information regarding long-term survival in this setting. The purpose of the present study was to compare the long-term survival of patients subjected to CABG after thrombolysis to those without thrombolysis. Methods and Results - We studied 3760 consecutive patients with isolated CABG between 1992 and 2002. CABG patients without thrombolysis were compared with those who were treated with thrombolysis within 7 days before CABG. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for thrombolysis was determined by logistic regression analysis, and each patient with thrombolysis was then matched to 5 patients without thrombolysis. One hundred ninety-six patients (5.2%) were treated with thrombolysis. Patients with thrombolysis were more likely to be male, younger, and with higher rates of unstable angina, emergency operation, recent or transmural myocardial infarction, preoperative intraaortic balloon pump, hemodynamic instability, shock, intravenous nitroglycerine, left-ventricular hypertrophy, sustained ventricular arrhythmia, and higher EuroSCORE. There were no differences in early outcome between matched groups, but the 5-year actuarial survival was higher in patients with thrombolysis (90.3±2.2% versus 78.5±1.6%; P=0.0007). After adjustment for all factors, the hazard ratio of long-term mortality for patients with thrombolysis was 0.54 (95% CI, 0.36 to 0.81; P=0.003) and, if deaths during the first 12 months were excluded, 0.46 (95% CI, 0.27 to 0.76; P=0.003). Conclusions - Patients subjected to CABG within 7 days after thrombolysis demonstrated increased long-term survival.

KW - Coronary artery bypass grafting

KW - Long-term mortality

KW - Thrombolysis

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