title: 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.
authors.affiliation: Department of Internal Medicine, Outcomes Research Unit and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon; Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Md.
authors.forename: Victor
authors.initials: V
authors.lastname: Nauffal
authors.affiliation: Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schwann
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Maroun B
authors.initials: MB
authors.lastname: Yammine
authors.affiliation: Department of Internal Medicine, Outcomes Research Unit and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon.
authors.forename: Abdul-Karim M
authors.initials: AK
authors.lastname: El-Hage-Sleiman
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Md.
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: El Zein
authors.affiliation: Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, Ohio.
authors.forename: Ameer
authors.initials: A
authors.lastname: Kabour
authors.affiliation: Department of Anesthesia, University of Michigan, Ann Arbor, Mich.
authors.forename: Milo C
authors.initials: MC
authors.lastname: Engoren
authors.affiliation: Department of Internal Medicine, Outcomes Research Unit and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon. Electronic address: rh106@aub.edu.lb.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Habib
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016208:Databases, Factual; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome