title: On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.
abstract: OBJECTIVE
  Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes.
  
  
  METHODS
  The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score.
  
  
  RESULTS
  On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes.
  
  
  CONCLUSIONS
  Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ashima
authors.initials: A
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Mori Brooks
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Frye
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA sako@uthscsa.edu.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Sako
mesh_terms: D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D009204:Myocardial Revascularization / Q000401:mortality*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D020521:Stroke / Q000209:etiology / Q000401:mortality
keywords: Coronary arteries bypass graft; Diabetic patients; Off-pump procedure