title: Myocardial protection and early outcome of different coronary surgical techniques for diabetic patients with triple vessels.
abstract: OBJECTIVE
  For patients with diabetes and triple-vessel disease, coronary artery bypass grafting (CABG) surgery is a well-established procedure, but cardiopulmonary bypass support may also lead to severe complications to these patients. The aim of this study was to compare myocardial protection and early outcomes in patients with diabetes and triple-vessel disease following different coronary surgical techniques.
  
  
  METHODS
  Prospective randomized trial of patients treated at the First Affiliated Hospital of China Medical University over a 3-year period (2011- 2013).
  
  
  METHODS
  In a single-center randomized trial, 668 patients with diabetes and triple-vessel disease were randomly assigned to off-pump (OPCAB) (number [n]=222), on-pump beating heart (OnP-BH) (n=223), and conventional CABG (OnP) (n=223) between January 2011 and October 2013. Myocardial injury was assessed by measuring the serial release of cardiac troponin I (cTnI) preoperatively, 1 hour, 12 hours, 24 hours, and 72 hours postoperatively. The early outcomes were compared among these 3 groups.
  
  
  RESULTS
  Preoperative characteristics of the patients in all 3 groups were similar. No significant difference was found regarding the number of anastomoses, the use of the internal thoracic artery, postoperative new-onset atrial fibrillation, hemodialysis, stroke, reoperation for bleeding, and infective complications in the 3 groups (P > .05). The complete revascularization, postoperative drainage loss, intra-aortic balloon pump support, blood requirements, postoperative myocardial infarction, pulmonary complications, gastrointestinal complications, inotropic requirements > 24 hours, ventilation > 24 hours, intensive care unit stay > 24 hours, and in-hospital stay > 7 days were significantly lower in the OPCAB group than in the other 2 groups (P < .05). In-hospital mortality was lower in the OPCAB group than in the other 2 groups, but no statistical difference was observed (P > .05). Preoperative cTnI in the 3 groups was similar (P > .05); however, the lowest cTnI value was noted in the OPCAB group, followed by the OnP group, and it was highest in the OnP-BH group 1 hour, 12 hours, 24 hours, and 72 hours postoperatively (P < .05).
  
  
  CONCLUSIONS
  OPCAB is superior to the OnP-BH and OnP techniques in terms of postoperative complications and myocardial protection in patients with diabetes and triple-vessel disease. Myocardial injury in the OnP-BH group was significantly higher than that in the OnP group.
authors.forename: Yu
authors.initials: Y
authors.lastname: Lei
authors.affiliation: Dr. Tianziang Gu, Department of Cardiac Surgery, China Medical University, First Affiliated Hospital, Shenyang, China, T: 86-24-83283455, F: 86-24-83283455, cmuyulei@aliyun.com.
authors.forename: Tianxiang
authors.initials: T
authors.lastname: Gu
authors.forename: Enyi
authors.initials: E
authors.lastname: Shi
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.forename: Fang
authors.initials: F
authors.lastname: Qin
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002316:Cardiotonic Agents / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D011184:Postoperative Period; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D002316:Cardiotonic Agents; D019210:Troponin I
references.citation: N Engl J Med. 2013 Mar 28;368(13):1179-88
references.pmid: 23477676
references.citation: JAMA. 2013 Nov 20;310(19):2086-95
references.pmid: 24240936
references.citation: Eur J Cardiothorac Surg. 2005 Jun;27(6):1057-64
references.pmid: 15896617
references.citation: N Engl J Med. 1998 Jul 23;339(4):229-34
references.pmid: 9673301
references.citation: N Engl J Med. 2009 Mar 5;360(10):961-72
references.pmid: 19228612
references.citation: Eur Heart J. 2012 May;33(10):1257-67
references.pmid: 21987177
references.citation: Ann Thorac Surg. 2014 Mar;97(3):831-6
references.pmid: 24200395
references.citation: N Engl J Med. 2009 Nov 5;361(19):1827-37
references.pmid: 19890125
references.citation: Eur J Cardiothorac Surg. 2011 Jul;40(1):233-9
references.pmid: 21167727
references.citation: Arq Bras Cardiol. 2001 Aug;77(2):107-19
references.pmid: 11514822
references.citation: Ann Thorac Surg. 2013 Aug;96(2):528-34
references.pmid: 23791161
references.citation: N Engl J Med. 2012 Apr 19;366(16):1489-97
references.pmid: 22449296
references.citation: Nephrol Dial Transplant. 2012 May;27(5):2059-65
references.pmid: 21956251
references.citation: J Thorac Cardiovasc Surg. 2008 Mar;135(3):521-6
references.pmid: 18329463
references.citation: Ann Thorac Surg. 1997 Nov;64(5):1368-73
references.pmid: 9386706
references.citation: J Thorac Cardiovasc Surg. 2010 Sep;140(3):e45-7
references.pmid: 20074752
references.citation: Ann Saudi Med. 2012 Mar-Apr;32(2):156-61
references.pmid: 22366829
references.citation: Stroke. 2006 Nov;37(11):2759-69
references.pmid: 17008617
references.citation: Ann Thorac Surg. 1997 Apr;63(4):988-92
references.pmid: 9124976
references.citation: Circulation. 2000 Nov 7;102(19 Suppl 3):III84-9
references.pmid: 11082368
references.citation: J Am Coll Cardiol. 2002 Sep 4;40(5):946-53
references.pmid: 12225721
references.citation: J Am Coll Cardiol. 2010 Mar 16;55(11):1067-75
references.pmid: 20079596
references.citation: Circulation. 2008 Nov 18;118(21):2130-8
references.pmid: 18981306
references.citation: Ann Thorac Surg. 2011 Jun;91(6):1836-42; discussion 1842-3
references.pmid: 21619980
references.citation: Circulation. 1999 Sep 28;100(13):1464-80
references.pmid: 10500052
references.citation: Ann Thorac Surg. 1993 Feb;55(2):552-9
references.pmid: 8431082
references.citation: J Thorac Cardiovasc Surg. 2004 Nov;128(5):655-61
references.pmid: 15514591