Impact of prior intracoronary stenting on late outcomes of coronary artery bypass surgery in diabetics with triple-vessel disease

Abstract

Objective Recent studies have indicated that coronary artery bypass grafting (CABG) outcomes in patients with prior stents are suboptimal. We aimed to study the impact of prior percutaneous coronary intervention (PCI) with stenting (PCI-S) on late CABG mortality in diabetic patients with triple-vessel disease. Methods We reviewed the primary nonemergency CABG experience from a single U.S. institution (n = 7005; 1996–2007, Toledo, Ohio). Diabetics with triple-vessel disease (n = 1583) were identified and divided into 2 groups: (1) prior PCI-S (n = 202); and (2) no prior PCI (No-PCI [n = 1381]). Hierarchic Cox proportional hazards models were used to assess the effect of prior PCI-S on 5-year mortality after CABG. A propensity score for PCI-S and No-PCI patients was derived using a nonparsimonious logistic regression and used to generate a 1:1 (PCI-S to No-PCI) matched cohort. Results In model 1, after adjusting for preoperative clinical characteristics, medications, off-pump surgery, and isolated CABG surgery status, prior PCI-S was associated with a 39% increased risk of mortality (hazard ratio [HR] = 1.39, with 95% confidence interval [CI; 1.02, 1.90]; P = .04). Further adjustment for date of surgery (model 2) (HR = 1.39, with 95% CI [1.02, 1.91]; P = .04) or operative parameters (model 3) (HR = 1.38, with 95% CI [1.01, 1.88]; P = .046) did not alter the association. The 1:1 matched-cohort analysis confirmed the increased risk associated with PCI-S (HR = 1.61, with 95% CI [1.03, 2.51]; P = .037). Conclusions Patients who have both diabetes and triple-vessel disease, and have undergone prior PCI-S, have poorer long-term outcomes after CABG compared with those who have had no prior PCI-S.

Impact of previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting

“…Furthermore, in logistic regression analysis, higher risk of long-term mortality and grafts occlusion was observed in patients with diabetes who previously had underwent PCI. This is consistent with the study of Nauffal et al reporting poorer long-term outcomes after CABG in diabetes patients with a history of PCI [20]. At the same time, no significant differences between studied groups were observed in terms of in-hospital morbidity and mortality.…”

Does prior coronary angioplasty affect outcomes of surgical coronary revascularization? Insights from the STICH trial

“…Second, we collected no detailed information specific to the intervention performed. The modern practice of PCI is complex and how data from the current study relates to that practice is unknown and may have influenced the results (13,21). However, this is the only report we are aware of limited to a population with LV dysfunction maintained on optimal medical therapy that analyzes the impact of prior PCI in patients undergoing CABG or maintained on MED alone.…”

Coronary Bypass Surgery in a Patient After Repeated Stenting of the Coronary Arteries (How Many Repeated Pci Are Appropriate?)

“…Tran and colleagues [16] описали снижение двухлетней выживаемости после КШ среди пациентов с диабетом и ЧКВ в анамнезе. V. Nauffal et colleagues [17] при сравнении пациентов с диабетом и трехсосудистым поражением также показали, что наличие стентирования в анамнезе увеличивает 5-летнюю общую смертность по сравнению с пациентами без стентирования.…”