Total arterial off-pump coronary artery bypass grafting was not associated with inferior outcomes for diabetic when compared with non-diabetic patients.
OBJECTIVE
Diabetes mellitus is a strong risk factor that worsens the clinical outcome of patients undergoing coronary artery bypass grafting (CABG). With the development of the off-pump CABG technique, there is a current trend in revascularization strategies towards in situ all-arterial grafting. We were interested in whether total arterial off-pump CABG could improve the outcome for diabetic patients.


METHODS
From January 2002 to December 2013, a total of 1064 patients underwent off-pump CABG at our institution, with total arterial reconstruction carried out in 775 cases. Of the 775 patients, 436 had diabetes (DM) and 339 did not (nDM). After propensity score matching, 301 cases from each group were successfully matched.


RESULTS
All procedures were performed via the off-pump technique without conversion to on-pump. Four patients in the DM group and 1 in the nDM group died in hospital. Multivariate analysis revealed that chronic pulmonary disease [odds ratio (OR) 7.04, P = 0.036] and low (<40%) ejection fraction (OR 11.3, P = 0.009) are independent risk factors for hospital death, and advanced age for deep sternal infection (OR 1.07, P = 0.04). Follow-up was completed in 97.7% of the patients to a maximum of 11.9 years. The rate of 10-year freedom from all-cause mortality was 84.2% in the DM and 74.3% in the nDM group (P = 0.45). The corresponding rates for major adverse cardiac event were 93.3 and 86.9% (P = 0.09). Multivariate Cox regression analysis revealed chronic renal failure, older age, cerebrovascular accident, low ejection fraction and urgency as significant predictors of late death. Diabetes was not associated with any long- or short-term outcome.


CONCLUSIONS
Total arterial off-pump CABG using skeletonization technique can provide similar clinical outcome for diabetic patients in the long as well as in the short term as that for non-diabetic patients.
Shiga University of Medical Science, Shiga, Japan suzukit@belle.shiga-med.ac.jp.
Tomoaki
T
Suzuki
Shiga University of Medical Science, Shiga, Japan.
Tohru
T
Asai
Shiga University of Medical Science, Shiga, Japan.
Takeshi
T
Kinoshita
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016896:Treatment Outcome
Coronary disease