Abstract 2122: Prognostic Impact of Previous Percutaneous Coronary Intervention in Patients with Diabetic 3-Vessel Coronary Artery Disease Undergoing Coronary Artery Bypass Surgery
Background: Although randomized trials and ’real-world’ registries have clearly shown that coronary artery bypass grafting (CABG) is the superior revascularization strategy in terms of survival and re-intervention rate in patients with diabetic three-vessel coronary artery disease (3VD), percutaneous coronary intervention (PCI) is frequently performed without any supporting data from the literature.
Objectives: We sought to determine, whether previous PCI has a prognostic impact on surgical outcome in patients with diabetes mellitus and 3VD finally referred to CABG therapy.
Methods: Between 01/2000 and 03/2006, 621 consecutive patients with medical or insulin-treated diabetic 3VD scheduled for isolated first-time CABG as the primary revascularization procedure (group 1) were retrospectively analyzed for in-hospital mortality and major adverse cardiac events (MACE), and compared with 128 diabetic 3VD patients treated with previous PCI before CABG (group 2). Prospectively recorded clinical data were screened for in-hospital death from any cause and MACE, including perioperative myocardial infarction (PMI), low cardiac output syndrome (LCOS), cardiac death (CD), and sudden cardiac death (SCD). A propensity score matching was performed to adjust for baseline differences between the two groups.
Results: PMI was identified in 5.8% in group 1 and 11.7% in group 2 (odds ratio [OR], 2.17, 95% confidence interval [CI], 1.09−4.27; P=0.02). LCOS occurred in 2.6% and 7.0% in the groups (OR, 2.99, CI, 1.19−7.37; P=0.01), respectively. Overall in-hospital mortality was 2.9% in group 1, 7.8% in group 2 (OR, 2.96, CI, 1.24−6.99; P=0.02), whereas CD occurred in 2.1% and 7.0% (OR, 3.69, CI, 1.42−9.49; P=0.005), and SCD in 0.3% and 2.3% (OR, 7.49, CI, 1.01−64.6; P=0.04) in the groups, respectively. Risk-adjusted multivariable logistic regression analysis of previous PCI before CABG significantly correlated with in-hospital mortality (P=0.03) and MACE (P=0.03). After propensity matching, conditional regression analysis confirmed previous PCI to be associated with in-hospital mortality (P=0.03) and MACE (P=0.02).
Conclusions: Previous PCI before CABG independently increases the risk for in-hospital mortality and MACE in patients with diabetic 3VD.