title: Coronary revascularization in diabetic patients: off-pump versus on-pump surgery.
abstract: BACKGROUND
  Coronary artery bypass grafting (CABG) is a well-established procedure for treating diabetic patients with multivessel disease, but extracorporeal circulation and cardioplegia-induced cardiac arrest introduce a severe burden to these patients. The present study investigated if off-pump CABG decreases 30-day mortality and mid-term mortality in diabetic patients in comparison with conventional CABG.
  
  
  METHODS
  From February 2009 through October 2011, data from 355 consecutive adult diabetic patients undergoing off-pump CABG and 502 patients undergoing on-pump CABG were prospectively recorded. Data analysis was performed by propensity score (PS)-adjusted logistic regression analysis and PS-adjusted Cox regression analysis. The primary endpoint was 30-day mortality. Secondary endpoints were major complications and mortality on follow-up.
  
  
  RESULTS
  Off-pump CABG was associated with a significantly lower 30-day mortality rate (0.3% vs 4.2%; adjusted odds ratio [OR] = 0.09 [95% confidence interval (CI):0.01 to 0.70] p = 0.021) than on-pump CABG. Results coincided with a lower rate of postoperative neurologic complications in patients undergoing off-pump CABG (1.7% vs 5.4%; adjusted OR = 0.31 [95% CI: 0.12 to 0.77] p = 0.012) and a less frequent need for hemofiltration in these patients (3.4% vs 10.4%; adjusted OR = 0.30 [95% CI: 0.14 to 0.64] p = 0.002). The off-pump technique decreased the 6-month mortality rate (2.3% vs 8.8%; adjusted hazard ratio = 0.27 [95% CI: 0.12 to 0.61] p = 0.002) and also the 1-year mortality rate (4.0% vs 10.6%; adjusted hazard ratio = 0.40 [95% CI: 0.22 to 0.75] p = 0.004) significantly.
  
  
  CONCLUSIONS
  Our data indicate that in terms of postoperative complications and early and mid-term survival, off-pump CABG is superior to the on-pump technique in diabetic patients.
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. arenner@hdz-nrw.de
authors.forename: André
authors.initials: A
authors.lastname: Renner
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Anas
authors.initials: A
authors.lastname: Aboud
authors.forename: Thomas
authors.initials: T
authors.lastname: Pühler
authors.forename: Kavous
authors.initials: K
authors.lastname: Hakim-Meibodi
authors.forename: Wulf
authors.initials: W
authors.lastname: Quester
authors.forename: Diethelm
authors.initials: D
authors.lastname: Tschoepe
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate
keywords: 23; ACT; ANCOVA; BMI; CABG; DM; ECC; EF; GFR; IABP; ICU; LOS; MVD; OR; PS; aPTT; activated clotting times; activated partial thromboplastin time; analysis of covariance; body mass index; coronary artery bypass grafting; diabetes mellitus; ejection fraction; extracorporeal circulation; glomerular filtration rate; intensive care unit; intraaortic balloon pump; low output syndrome; multi-vessel disease; odds ratio; propensity score