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(Circulation. 2008;118:S222-S225.)
© 2008 American Heart Association, Inc.

Surgery for Coronary Artery Disease

The Impact of Diabetic Status on Coronary Artery Bypass Graft Patency

Insights From the Radial Artery Patency Study

Steve K. Singh, MD; Nimesh D. Desai, MD; Stephanie D. Petroff, BSc; Saswata Deb, BSc; Eric A. Cohen, MD; Sam Radhakrishnan, MD; Leonard Schwartz, MD; James Dubbin, MD; Stephen E. Fremes, MD, for the Radial Artery Patency Study Investigators

From the Divisions of Cardiac and Vascular Surgery (S.K.S., N.D.D., S.D.P., S.D., S.E.F.) and Cardiology (E.A.C., S.R., J.D.), Sunnybrook Health Sciences Centre, Toronto, Canada; and the Division of Cardiology (L.S.), Toronto General Hospital, Toronto, Canada.

Correspondence to Stephen E. Fremes, MD, 2075 Bayview Avenue, Suite H410, Toronto, Canada M4N 3M5. E-mail stephen.fremes{at}sunnybrook.ca

Background— Despite worse outcomes in diabetics after coronary artery bypass grafting surgery, studies have not examined graft patency in this high-risk group. This study examined the impact of diabetes on graft patency, 1-year postcoronary artery bypass grafting, using data from a multicenter randomized trial.

Methods and Results— The Radial Artery Patency Study enrolled 561 patients undergoing coronary artery bypass grafting, comparing graft patency of the saphenous vein (SV) versus radial artery 1-year postcoronary artery bypass grafting. Angiographic follow-up was acquired for 440 patients (115 diabetics, 325 nondiabetics), each with a study radial artery and a control SV graft. Preoperative characteristics were similar. The proportion of small-sized target vessels was greater in diabetics (P=0.04). At 1 year, 33 of 230 study grafts (14.4%) were occluded in the diabetics versus 63 of 650 (9.7%) in the nondiabetics (P=0.052). Multivariable regression found diabetes to be a significant independent predictor of 1-year graft occlusion (relative risk, 1.45; 95% CI, 1.03 to 2.05; P=0.03) along with female gender, SV conduit, and small target-vessel size. A significantly higher proportion of SV grafts were occluded in the diabetics (19% versus 12%, P=0.04). Radial artery grafting was protective in the diabetic cohort (radial artery: 11 of 115 occluded [9.5%] versus SV: 22 of 115 occluded [19.1%], McNemar corrected P=0.05; relative risk, 0.42; 95% CI, 0.16 to 1.01) and nondiabetics (radial artery: 25 of 325 occluded [7.7%] versus SV: 38 of 325 occluded [11.7%], McNemar corrected P=0.11; relative risk, 0.63; 95% CI, 0.35 to 1.10).

Conclusions— Coronary artery bypass grafting occlusions were more common among diabetics versus nondiabetics at 1-year angiography, mainly because of more frequent SV graft failure in diabetics. Radial artery, compared with SV grafting, is protective in both diabetic and nondiabetic patients.

Key Words: bypass • diabetes mellitus • restenosis • risk factors • surgery