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J Thorac Cardiovasc Surg 2009;138:316-323
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

The effect of previous coronary artery stenting on short- and intermediate-term outcome after surgical revascularization in patients with diabetes mellitus

Henry A. Tran, MD, MSc, Scott D. Barnett, PhD, Sharon L. Hunt, MBA, Andrew Chon, MD, Niv Ad, MD*

Inova Heart and Vascular Institute, Falls Church, Va

Received for publication January 5, 2009; revisions received February 20, 2009; accepted for publication March 8, 2009.

* Address for reprints: Niv Ad, MD, Cheif, Cardiac Surgery, Inova Heart and Vascular Institute, 3300 Gallows Rd, Falls Church, VA 22042. (Email: niv.ad{at}inova.org).

Objectives: Percutaneous intervention for coronary revascularization is associated with an increased risk of repeat revascularization, especially in patients with diabetes mellitus. In this study we sought to examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome and intermediate-term survival in patients undergoing coronary artery bypass surgery.

Methods: Between January 1, 2001, and December 31, 2006, 1758 consecutive patients with diabetes mellitus who underwent first-time isolated coronary artery bypass surgery were identified. Survival and major perioperative complications for 1537 patients who did not have prior percutaneous intervention (group 1) were compared with those in 221 patients with prior percutaneous intervention (group 2) after adjusting for baseline risk factors. Vital status was determined by using the National Death Index and Social Security Death Index. Age-adjusted survival at 2 years' follow-up was calculated with the Cox singular proportional hazards model.

Results: At baseline, group 2 patients had higher incidences of hypercholesterolemia and myocardial infarction. Compared with group 1 patient, group 2 patients had significantly higher operative mortality (adjusted odds ratio, 4.05; 95% confidence interval, 1.41–11.63), perioperative major adverse cardiac events (adjusted odds ratio, 2.72; 95% confidence interval, 1.08–6.85), and atrial fibrillation (adjusted odds ratio, 1.97; 95% confidence interval, 1.29–3.01). Group 2 patients had worse age-adjusted survival at 2 years' follow-up (93.4% vs 87.4%, P < .017).

Conclusions: Patients with diabetes mellitus and a history of percutaneous coronary stenting before coronary artery bypass surgery were found to have an increased risk of operative death, increased perioperative complications, and decreased age-adjusted survival at 2 years' follow-up.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CI = confidence interval; EF = ejection fraction; MACE = major adverse cardiac event; MI = myocardial infarction; OE = observed/expected; OR = odds ratio; PCI = percutaneous coronary intervention; STS = Society of Thoracic Surgeons


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