Published Online
on October 28, 2002

A more recent version of this article appeared on November 19, 2002

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Submitted on July 29, 2002
Accepted on September 6, 2002

Coronary Bypass Graft Patency in Patients With Diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

Leonard Schwartz MD, Kevin E. Kip PhD^*, Robert L. Frye MD, Edwin L. Alderman MD, Hartzell V. Schaff MD, and Katherine M. Detre MD

From Toronto General Hospital, Toronto, Canada (L.S.); the Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (K.E.K., K.M.D.); the Mayo Clinic, Rochester, Minn (R.L.F., H.V.S.); and Stanford University Medical Center, Palo Alto, Calif (E.L.A.).

^* To whom correspondence should be addressed. E-mail: kipk{at}edc.gsph.pitt.edu.

Background—Few studies have compared long-term status of bypass grafts between patients with and without diabetes, and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG.

Methods and Results—Among 1526 patients in BARI who underwent CABG as initial revascularization, 99 of 292 (34%) with treated diabetes mellitus (TDM) (those on insulin or oral hypoglycemic agents) and 469 of 1234 (38%) without TDM had follow-up angiography. Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention (mean 3.9 years) were reviewed. An average of 3.0 grafts were placed at initial CABG for patients with TDM (n=297; internal mammary artery [IMA], 33%) and 2.9 grafts for patients without TDM (n=1347; IMA, 34%). Patients with TDM were more likely than those without to have small (<1.5 mm) grafted distal vessels (29% versus 22%) and vessels of poor quality (9% versus 6%). On follow-up angiography, 89% of IMA grafts were free of stenoses 50% among patients with TDM versus 85% among patients without TDM (P=0.23). For vein grafts, the corresponding percentages were 71% versus 75% (P=0.40). After statistical adjustment, TDM was unrelated to having a graft stenosis 50% (adjusted odds ratio, 0.87; 95% CI, 0.58 to 1.32).

Conclusions—Despite diabetic patients' having smaller distal vessels and vessels judged to be of poorer quality, diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up. Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes.

Key words: angiography • bypass • surgery • diabetes mellitus • follow-up studies

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