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Impact of Previous PCI on Hospital Mortality After Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients With Multivessel Disease

Kinoshita, Takeshi MD*; Asai, Tohru MD, PhD*; Murakami, Yoshitaka PhD; Takashima, Noriyuki MD*; Hosoba, Soh MD*; Nishimura, Osamu MD*; Ikegami, Hirohisa MD*; Hiramatsu, Norihiko MD*; Suzuki, Tomoaki MD*; Kambara, Atsushi MD*; Matsubayashi, Keiji MD, PhD*

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November-December 2009 - Volume 4 - Issue 6 - p 334-339
doi: 10.1097/IMI.0b013e3181c47194
Original Article

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.

From the Departments of *Cardiovascular Surgery and †Health Statistics, Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan.

Accepted for publication August 12, 2009.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, Boston, MA USA, June 11–14, 2008.

Address correspondence and reprint requests to Takeshi Kinoshita, MD, Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, 520-2192 Japan. E-mail: kinotake@belle.shiga-med.ac.jp.

© 2009 Lippincott Williams & Wilkins, Inc.