The presence of PAD is an independent predictor of early1241 and late death in CABG patients. In the STS National Cardiac Surgery Database, 774 881 patients underwent isolated CABG over a 5-year period, of whom 15.5% had PAD. The presence of PAD was an independent risk factor for in- hospital death or death within 30 days of CABG. In addition, PAD was an independent risk factor for perioperative stroke and subsequent need for post-CABG limb revascularization or amputation. Potential but unproven explanations for the adverse effects of PAD on long-term survival after CABG include: 1) The presence of PAD may lead to vascular events (ie, cerebrovascular events) that adversely affect post-CABG survival; 2) PAD may be a marker for more severe CAD, which may lead to an increased rate of post-CABG death from cardiac causes despite revascularization; and 3) PAD may contribute to noncardiovascular death in the long term. Revascularization of PAD before CABG is not known to improve post-CABG outcomes. 7. Economic Issues 7.1. Cost-Effectiveness of CABG and PCI In the United States, it is estimated that the annual hospital costs of CABG are approximately $10 billion.1242 Despite the increasing risk profile of CABG candidates, it nonetheless is becoming more cost-effective. Hospital charges from the Nationwide Inpatient Sample of nearly 5.5 million patients who had isolated CABG in the United States from 1988 to 2005 were examined.1243 A decrease in risk-adjusted mortal- ity rate, from 6.2% to 2.1% (P 0.0001), was noted. When hospital costs were corrected for inflation, they declined from $26 210 in 1988 to $19 196 in 2005 ($1988) (P 0.0001). 