Abstract 15277: Long-term Mortality Following Minimally Invasive Coronary Artery Bypass Surgery in Diabetics.
Background: Cardiovascular disease is the main cause of death in patients with diabetes mellitus, which increases the risk of diffuse, progressive atherosclerosis in coronary arteries. Diabetic patients with multivessel disease have a significant survival benefit after coronary artery bypass graft (CABG). The long term outcome after minimally invasive coronary artery bypass grafting (MC) has not been fully evaluated. The aim of our study was to explore the long term outcome after MC and sternotomy CABG (SC) in diabetics with coronary artery disease.
Method: This is a retrospective study of 2073 patients that underwent CABG between 2005 and 2011. Patients were divided into diabetics (n=762) and non-diabetics (n=1,311) and divided further for a subgroup analysis according to type of procedure, MC (left lateral thoracotomy) and SC. Propensity score matching utilized to evaluate all-cause mortality. The diabetics (n=195 per group) and non-diabetics (n=359 per group) were evaluated with average number of bypasses per procedure and Kaplan-Meier estimate for survival.
Result: All patients were followed for a maximum of 10 years, with a mean of 6.4±2.7 years. Total number of bypasses performed in diabetics was 3.2±1.1 in SC and 2.5±0.9 in MC (p<0.0001) and in non-diabetics SC received 3.3±1.0 and 2.4±0.8 in MC (p<0.0001). Among diabetic patients, SC had a significantly lower all-cause mortality than MC (14% vs. 25%, respectively, p=0.009), with no difference in the non-diabetics (16% vs. 18%, respectively, p=0.432). In addition, SC demonstrated improved survival compared to MC in diabetic patients, log-rank p=0.004 with comparable survival for SC and MC in non-diabetic patients, log-rank p=0.840.
Conclusion: Sternotomy CABG demonstrates significantly lower long-term mortality and improved survival compared to minimally invasive CABG in diabetic patients with coronary artery disease. Survival was comparable between non-diabetics, regardless of surgical approach. Therefore, the presence of diabetes mellitus should be considered carefully when choosing surgical approach for CABG. Further study is required to determine whether completeness of revascularization plays a greater role in the survival of diabetics than for non-diabetics.
Author Disclosures: E.A. Barsoum: None. B. Azab: None. M. Shariff: None. J. Nabagiez: None. J. Lafferty: None. J.T. McGinn: None.
- © 2016 by American Heart Association, Inc.