Dong Seop Jeong1, Kiick Sung1, Young Tak Lee2, Joong Hyun Ahn3, K C Carriere3, Wook Sung Kim1, Pyo Won Park1. 1. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: ytlee1955@gmail.com. 3. Department of Mathematical and Statistical Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Despite the documented superior long-term patency of bilateral internal thoracic artery (BITA) grafting, use of BITAs remains low, especially in diabetic patients. We analyzed the results of pure BITA grafting to determine whether the potential survival advantage outweighs the risk of wound infection in diabetic patients. METHODS: We performed a retrospective analysis of 791 consecutive patients (389 diabetic, 402 nondiabetic) with triple-vessel disease who underwent off-pump coronary artery bypass using only skeletonized BITAs from 2001 to 2010. We used propensity score matching to match 315 nondiabetic patients with diabetic patients. RESULTS: The groups did not differ significantly regarding 10-year survival (diabetic, 84.2% ± 4.5%; nondiabetic, 80.8% ± 4.7%; p = 0.828) or freedom from major adverse cardiovascular events (diabetic, 73.5% ± 5.2%; nondiabetic, 71.8% ± 5.3%; p = 0.431). Diabetes was not predictive of deep sternal infection (odds ratio, 1.11; 95% confidence interval, 0.23 to 5.31; p = 0.895). Results of stratified competing risks regression analysis showed that the risk of target vessel revascularization in diabetic patients was similar to that of nondiabetic patients (subdistribution hazard ratio, 0.67; 95% confidence interval, 0.16 to 2.80; p = 0.585). CONCLUSIONS: Off-pump coronary artery bypass grafting using pure BITAs produced excellent clinical outcomes in both diabetic and nondiabetic patients. This strategy did not increase the incidence of deep sternal infection in diabetic patients. We recommend BITA grafting, which has proven long-term patency, as a strategy of choice in diabetic patients.
BACKGROUND: Despite the documented superior long-term patency of bilateral internal thoracic artery (BITA) grafting, use of BITAs remains low, especially in diabeticpatients. We analyzed the results of pure BITA grafting to determine whether the potential survival advantage outweighs the risk of wound infection in diabeticpatients. METHODS: We performed a retrospective analysis of 791 consecutive patients (389 diabetic, 402 nondiabetic) with triple-vessel disease who underwent off-pump coronary artery bypass using only skeletonized BITAs from 2001 to 2010. We used propensity score matching to match 315 nondiabetic patients with diabeticpatients. RESULTS: The groups did not differ significantly regarding 10-year survival (diabetic, 84.2% ± 4.5%; nondiabetic, 80.8% ± 4.7%; p = 0.828) or freedom from major adverse cardiovascular events (diabetic, 73.5% ± 5.2%; nondiabetic, 71.8% ± 5.3%; p = 0.431). Diabetes was not predictive of deep sternal infection (odds ratio, 1.11; 95% confidence interval, 0.23 to 5.31; p = 0.895). Results of stratified competing risks regression analysis showed that the risk of target vessel revascularization in diabeticpatients was similar to that of nondiabetic patients (subdistribution hazard ratio, 0.67; 95% confidence interval, 0.16 to 2.80; p = 0.585). CONCLUSIONS: Off-pump coronary artery bypass grafting using pure BITAs produced excellent clinical outcomes in both diabetic and nondiabeticpatients. This strategy did not increase the incidence of deep sternal infection in diabeticpatients. We recommend BITA grafting, which has proven long-term patency, as a strategy of choice in diabeticpatients.