ISMICS: ISMICS 2007 Annual Meeting Influence of Prior Coronary Stenting on the Outcome of Isolated Coronary Artery Bypass Surgery

Influence of Prior Coronary Stenting on the Outcome of Isolated Coronary Artery Bypass Surgery

Michael B. Pliam, MD, PhD¹, Alex Zapolanski, MD¹, Peter Anastassiou, MD¹, Colman J. Ryan, MD², Louis L. Manila, RN¹, Richard E. Shaw, PhD¹.
¹Cardiac Surgery, San Francisco Heart & Vascular Institute, Daly City, CA, USA, ²Cardiology, San Francisco Heart & Vascular Institute, Daly City, CA, USA.
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 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 3 groups.
Group Prior Stents Frequency Percent
I No Stents 1317 89.5
II 1 to 3 Stents 137 9.3
III > 3 Stents 17 1.2
Total 1471 100.0

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 yrs, p = 0.006), had more unstable angina (68.2% vs 58.9%, p = 0.02), hypercholesterolemia (83.8% vs 61.2%, p = 0.00), COPD (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 ITA 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 days vs 8.3 days, p = 0.019). Percent survival for Groups I, II, and III at 60 months was 82.1%, 84.7%,and 72.6% respectively.
Conclusions: Stents placed prior to surgery in isolated CABG patients may be associated with higher preoperative risk, altered operative procedures, more postoperative complications, longer hospitalizations and more readmissions. Survival for those with more than 3 stents may be diminished.
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