title: Influence of Prior Coronary Stenting on the Immediate and Mid-term Outcome of Isolated Coronary Artery Bypass Surgery.
abstract: BACKGROUND
  : There has been little emphasis on the possible consequences of prior stent placement on the outcome of coronary bypass surgery (CABG). We compared the results of isolated CABG patients who had prior stents with those who had not with respect to preoperative status, operative procedure, and postoperative immediate and long-term outcome.
  
  
  METHODS
  : Records of 1471 patients undergoing isolated CABG at our institution between January 1, 2000, and March 31, 2005, were reviewed. Patients were divided into three groups. Group I had no stents (n = 1317). Group II had one to three stents (n = 137). Group III had more than three stents (n = 17). Groups were compared with respect to preoperative risk factors, operative procedures, and postoperative results. Long-term survival data were obtained on 97.6% of patients with a mean follow-up, 4.1 ± 2.3 years.
  
  
  RESULTS
  : Stented patients were younger (66.1 ± 10.8 vs. 69.1 ± 10.8 years, P = 0.006), had more unstable angina (68.2% vs. 58.9%, P = 0.02), hypercholesterolemia (83.8% vs. 61.2%, P = 0.00), chronic obstructive pulmonary disease (13.6% vs. 8.4%, P = 0.03), peripheral vascular disease (15.2% vs. 8.4%, P = 0.00), and previous CABG (10.1% vs. 4.2%, P = 0.00), fewer low ejection fractions (1.3% vs. 5.2%, P = 0.02), left main disease (25.3% vs. 32.6%, P = 0.04), diabetes (31.2% vs. 40.8%, P = 0.01), or diffuse disease (19.5 ± 10.5 vs. 22.5 ± 10.9, P = 0.00), had more off pump procedures (53.2% vs. 45.3%, P = 0.03), fewer internal thoracic artery grafts (80.5% vs. 86.6%, P = 0.03), fewer grafts placed (>3: 52.6% vs. 61.8%, P = 0.02), more complications (76.5% vs. 42.6%, P = 0.005), atrial fibrillation (47.1% vs. 19.7%, P = 0.011), longer hospital stays (12.2 vs. 8.3 days, P = 0.019). Percentage survival for groups I, II, and III at 60 months was 82.1%, 84.7%, and 72.6%, respectively.
  
  
  CONCLUSIONS
  : Stents placed before surgery in isolated CABG patients may be associated with higher preoperative risk, altered operative procedures, more postoperative complications, longer hospitalizations, and more readmissions. Overall, stented patients experienced more preoperative hospitalizations, catheterizations, and percutaneous coronary interventions (PCIs) than nonstented patients. Survival for those with more than three stents may be diminished.
authors.affiliation: *Department of Cardiovascular Surgery, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California; †Valley Columbia Heart Center, Ridgewood, New Jersey; ‡Clinical Research and Operations, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California; ¶Sutter Pacific Heart Centers, California Pacific Medical Center, San Francisco, California; and ∥Clinical Database Analysis, San Francisco Heart and Vascular Institute, Seton Medical Center, Daly City, California.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Pliam
authors.forename: Alex
authors.initials: A
authors.lastname: Zapolanski
authors.forename: Peter
authors.initials: P
authors.lastname: Anastassiou
authors.forename: Colman J
authors.initials: CJ
authors.lastname: Ryan
authors.forename: Louis L
authors.initials: LL
authors.lastname: Manila
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Bob-Kenneth
authors.initials: BK
authors.lastname: Pira