title: Impact of Previous PCI on Hospital Mortality After Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients With Multivessel Disease.
abstract: OBJECTIVE
  : Because percutaneous coronary intervention (PCI) has been performed excessively, many patients initially managed with PCI are being referred for coronary artery bypass grafting (CABG). The purpose of this study was to assess the impact of previous PCI on surgical mortality after off-pump CABG in diabetic patients with multivessel disease.
  
  
  METHODS
  : Between January 2002 and April 2008, 595 consecutive patients (99.8% off-pump) had isolated CABG by one single surgeon. Of these, 274 patients with diabetes mellitus and multivessel disease were retrospectively analyzed. Patients with previous PCI (n = 79) were compared with patients with no previous PCI (n = 196), and risk-adjusted impact of previous PCI on surgical mortality after CABG was determined using multivariate and propensity score analyses.
  
  
  RESULTS
  : All patients underwent off-pump CABG without conversion to cardiopulmonary bypass during operation. Patients with previous PCI had a significantly higher prevalence of history of myocardial infarction, renal dysfunction, and hemodialysis. Rates of surgical mortality were higher in patients with previous PCI (7.6% versus 1.0%, P = 0.008). After multivariate logistic regression analysis including all potential univariate predictors, previous PCI remained a strong predictor of surgical mortality [odds ratio (OR), 6.9; 95% confidence interval (CI), 1.2 to 42.1; P = 0.035]. After matching and regression adjustment by propensity score, the impact of previous PCI on surgical mortality was similar in direction (matching OR, 6.5; 95% CI, 0.8 to 55.0; P = 0.088; regression adjustment OR, 6.3; 95% CI, 1.2 to 33.6; P = 0.031).
  
  
  CONCLUSIONS
  : Previous PCI increases the risk of surgical mortality after off-pump CABG in diabetic patients with multivessel disease.
authors.affiliation: From the Departments of *Cardiovascular Surgery and †Health Statistics, Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Tohru
authors.initials: T
authors.lastname: Asai
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takashima
authors.forename: Soh
authors.initials: S
authors.lastname: Hosoba
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishimura
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Ikegami
authors.forename: Norihiko
authors.initials: N
authors.lastname: Hiramatsu
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kambara
authors.forename: Keiji
authors.initials: K
authors.lastname: Matsubayashi