Efficacy of multiple arterial coronary bypass grafting in patients with diabetes mellitus.
OBJECTIVE
Use of the left internal mammary artery in patients with diabetes mellitus and multivessel coronary artery disease is known to improve survival after coronary artery bypass grafting (CABG); however, the survival benefit of multiple arterial grafts (MAGs) in diabetic patients is debated. We investigated the efficacy of CABG performed with MAGs in diabetic patients.


METHODS
The overall patient group comprised 2618 consecutive patients who underwent isolated CABG at our hospital between 1990 and 2014. Perioperative characteristics, in-hospital outcomes and long-term outcomes were compared between diabetic (n = 1110) and non-diabetic patients (n = 1508). The long-term outcomes of diabetic and non-diabetic patients were analysed between those who received a single arterial graft (SAG) and those who received MAGs. Both full unmatched patient population and propensity-matched patient population analyses (diabetic cohort = 431 pairs, non-diabetic cohort = 577 pairs) were performed.


RESULTS
Preoperative comorbidities were much more common in the diabetic patients than in the non-diabetic patients; however, comorbidities were not associated with in-hospital outcomes (diabetes versus non-diabetes group, in-hospital mortality: 2.2 vs 1.5%; deep sternal wound infection: 2.2 vs 1.8%, P > 0.05). Although survival and freedom from major cardiac and cerebrovascular events (MACCEs) at 15 years were lower in the diabetes group than in the non-diabetes group (survival: 48.6 vs 55.0%, P = 0.019; MACCE-free survival: 40.8 vs 46.1%, P = 0.02), cardiac death-free survival at 15 years was similar (81.7 vs 83.9%, P = 0.24). Overall, 12-year survival was higher in both diabetic and non-diabetic patients treated with MAGs than in those treated with an SAG (64.9 vs 56.8%, P = 0.006, and 71.9 vs 60.5%, P < 0.001). Propensity-matched patient cohort analysis revealed improved 12-year survival with MAGs versus SAG in both the diabetes group (64.9 vs 58.8%, P = 0.041) and non-diabetes group (71.4 vs 63.8%, P = 0.014). Similarly, MACCE-free survival was improved in both groups.


CONCLUSIONS
A long-term survival advantage, with no increase in perioperative morbidity, is conferred with the use of multiple arterial bypass grafts not only in non-diabetic patients but also in diabetic patients.
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan yamaatsu@omiya.jichi.ac.jp.
Atsushi
A
Yamaguchi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Naoyuki
N
Kimura
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Satoshi
S
Itoh
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Koichi
K
Adachi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Koichi
K
Yuri
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Homare
H
Okamura
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Hideo
H
Adachi
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D017534:Radial Artery / Q000637:transplantation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
Arterial graft; Coronary artery bypass grafting; Diabetes