Comparison of outcomes in patients undergoing coronary bypass of patent versus restenosed bare metal stented coronary arteries.
It is unclear whether bypass of a patent stented artery affects clinical outcomes. We sought to compare the survival of patients who, as part of multisystem coronary artery bypass grafting, underwent revascularization of arteries with patent stents (<50% stenosis) or in-stent restenosis (>50% diameter stenosis). Of 550 consecutive patients with previously placed stents who underwent coronary artery bypass grafting from May 1995 to October 2003, we studied 399 who had only 1 stented vessel bypassed at surgery. Of these, 128 had coronary bypass to an artery with a patent stent and 271 had bypass to an artery with in-stent restenosis. Nonparametric survival estimates were obtained using the Kaplan-Meier method. A propensity-adjusted multivariate hazard model of group differences was generated using variables identified by bootstrap bagging. The unadjusted survival rate at 1 month, 1 year, and 5 years was 99.7%, 97.3%, and 89.1%, respectively, for the patent stent group and 96.6%, 93.9%, and 86.2%, respectively, for the in-stent restenosis group, a result of high early risk in the latter group. After adjusting for clinical variables, neither stent patency (p = 0.9) nor interval (p = 0.3) from stent placement was a risk factor, although advanced age, increased blood urea nitrogen, and preoperative atrial fibrillation were associated with poorer survival. In conclusion, survival after bypassing a patent stented coronary artery is comparable to that after bypassing a stented restenotic coronary artery.
Shishehbor
Mehdi H
MH
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Seshadri
Niranjan
N
Aktas
Mehmet
M
Acharya
Naveen
N
Gillinov
A Marc
AM
Blackstone
Eugene H
EH
Houghtaling
Penny L
PL
Migrino
Raymond Q
RQ
Ghaffari
Sasan
S
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology* / Q000601:surgery; D023903:Coronary Restenosis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*