title: Total Arterial Revascularization: A Superior Strategy for Diabetic Patients Who Require Coronary Surgery.
abstract: BACKGROUND
  Recent large randomized trials and metaanalyses have shown that, for patients with diabetes mellitus and advanced coronary artery disease, coronary artery bypass graft surgery (CABG) was superior to percutaneous intervention. We investigated whether total arterial revascularization (TAR) conferred an additional survival advantage for diabetic patients having CABG.
  
  
  METHODS
  We reviewed 63,592 cases from an audited, collaborative Australian cardiac surgical database. A total of 34,181 patients undergoing first time isolated CABG from 2001 to 2012 were identified. Of the 34,181, 11,642 (34.1%) were diabetic patients, and TAR was performed in 12,271 of 34,181 (35.9%). Of the 11,642 diabetic patients, TAR was performed in 3,795 (32.6%) and non-TAR in 7,847 (67.4%). Propensity matching resulted in 6,232 matched pairs of patients who did and patients who did not have TAR. Data were linked to the National Death Index.
  
  
  RESULTS
  In the propensity matched sample, of 6,232 diabetic patients, 2,017 (32.4%) underwent TAR and 1,967 (31.6%) did not (p = 0.337). Mean follow-up was 4.9 years. Perioperative mortality, including 30-day mortality, was similar: 1.2% (24 of 2,017) for TAR and 1.4% (28 of 1,967) for non-TAR (p = 0.506). Late mortality was less among diabetic patients who underwent TAR, 10.2% (205 of 2,017), than no TAR, 12.2% (240 of 1,967; p = 0.041). Kaplan-Meier survival for the diabetic TAR group at 1, 5, and 10 years was 96.2%, 88.9%, and 82.2%, respectively, versus 95.4%, 87.5%, and 78.3% for the diabetic non-TAR group (log rank, p = 0.036).
  
  
  CONCLUSIONS
  In a large propensity matched cohort of patients having CABG, TAR demonstrated further long-term prognostic benefit for diabetic patients, in the context of equivalent perioperative mortality.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia. Electronic address: james.tatoulis@mh.org.au.
authors.forename: James
authors.initials: J
authors.lastname: Tatoulis
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Wynne
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Skillington
authors.affiliation: Department of Surgery, University of Melbourne, Melbourne, Australia.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Buxton
mesh_terms: D001315:Australia / Q000453:epidemiology; D016063:Blood Loss, Surgical; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000601:surgery*; D016208:Databases, Factual; D048909:Diabetes Complications / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D009204:Myocardial Revascularization / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011379:Prognosis; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation; D012307:Risk Factors