title: Optimal conduit for diabetic patients: propensity analysis of radial and right internal thoracic arteries.
abstract: BACKGROUND
  Multiple arterial grafts, in addition to the left internal thoracic artery, improve long-term survival after coronary artery bypass grafting (CABG); yet, the use of this procedure remains low for both the right internal thoracic artery (RITA) and the radial artery (RA). To identify the optimal arterial conduit to deploy for revascularization of diabetic patients, we compared the outcomes for RA and RITA grafts to the circumflex coronary.
  
  
  METHODS
  From January 1, 1995, to December 31, 2011, 908 consecutive diabetic patients underwent first-time, isolated CABG (99% on-pump), 659 with the RA and 502 with the RITA, respectively, in two affiliated hospitals. Data were prospectively collected, and late mortality was determined from the Social Security Death Index. Propensity matching, based on preoperative and operative variables, identified 202 matched pairs from each group.
  
  
  RESULTS
  Long-term survival was similar for matched patients. Mortality, myocardial infarction, reoperation for bleeding, stroke, sepsis, and renal failure were not significantly different between groups. However, deep sternal wound infection (p<0.035) and respiratory failure (p<0.048) favored the RA group, in which the total major adverse events were significantly fewer (p=0.002).
  
  
  CONCLUSIONS
  In diabetic patients undergoing multivessel revascularization with either RA or RITA grafts to the circumflex coronary, long-term survival is similar. However, RA patients experienced significantly fewer respiratory or sternal wound adverse events. The RA is the preferred conduit to extend to more diabetic patients the recognized survival benefit of a multiple arterial graft strategy.
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York. Electronic address: dhoffman@chpnet.org.
authors.forename: Darryl M
authors.initials: DM
authors.lastname: Hoffman
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Kamellia R
authors.initials: KR
authors.lastname: Dimitrova
authors.affiliation: Office of Grants and Research, Beth Israel Medical Center, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lucido
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Gabriela R
authors.initials: GR
authors.lastname: Dincheva
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Geller
authors.affiliation: Division of Cardiothoracic Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York.
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Balaram
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Wilson
authors.initials: W
authors.lastname: Ko
authors.affiliation: Division of Cardiothoracic Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Swistel
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, New York.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tranbaugh
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology*; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000503:physiopathology / Q000637:transplantation*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D017534:Radial Artery / Q000503:physiopathology / Q000637:transplantation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency