Abstract 11162: Total Arterial Off-pump Coronary Artery Bypass Grafting Can Improve Clinical Outcome for Diabetes Mellitus Patients
Introduction: Diabetes mellitus is a strong risk factor that worsens the outcome of CABG. Following the development of the OPCAB technique, the current trend in revascularization strategy is toward in-situ all-arterial grafting.
Hypothesis: We were interested in whether OPCAB with total arterial conduit using the skeletonization technique could improve outcome for diabetes patients.
Methods: From January 2002 to December 2013, a total of 1,064 patients underwent isolated OPCAB at our institution, with total arterial reconstruction carried out in 775 (72.8%) cases. Of these 775 patients, 436 had diabetes (DM) and 319 did not (nDM). We compared the clinical results between the two groups using the propensity score matching technique.
Results: 301 cases from each group were successfully matched in a 1:1 manner. All procedures were performed via the off-pump technique without conversion to on-pump. Four patients in the DM group (4/301; 1.3%) and one in the nDM group (1/301; 0.3%) died in hospital after surgery. Multivariate analysis revealed that chronic pulmonary disease (OR:7.04, 95%CI1.13-43.5 p=0.036) and low ejection fraction (<40%)(OR:11.3 CI1.82-71.4 p=0.009) are independent risk factors for hospital death and advanced age (OR:1.07 CI1.001-1.151 p=0.44) for deep sternal infection. Follow-up was completed in 97.6% (588/602) of the patients to a maximum of 13 years. The rate of 12-year freedom from all causes of death was 67.4% in the DM and 74.4% in the nDM group (p=0.45). The corresponding rates for major adverse cardiac event were 74.6% and 86.9% (p=0.09). Multivariate Cox regression analysis revealed chronic renal failure, older age, cerebrovascular accident, low EF, and urgency as statistically significant predictors of late death. Diabetes mellitus was not associated to long-term outcome. A subanalysis using multivariate Cox analysis also showed that total arterial reconstruction is an independent predictor of improved long-term outcome for diabetic patients.
Conclusions: Off-pump coronary artery bypass grafting with total arterial grafting using the skeletonization technique can improve clinical outcome for diabetic patients in the long as well as the short-term.
- Coronary artery disease
- Diabetes mellitus
- Coronary artery bypass grafting (CABG)
- Coronary heart disease
Author Disclosures: T. suzuki: None. T. asai: None. T. kinoshita: None.
- © 2014 by American Heart Association, Inc.