Multiple Arterial Grafting During Coronary Artery Bypass Graft Surgery in Diabetic and Non-Diabetic Patients: A Short- and Long-Term Analysis at a Single Center

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Dec 17

PMID 39685551

Authors

Miralem Jasarevic

Oskar Krueger

Jan Strathmann

Marinela Jasarevic

Sharaf-Eldin Shehada

Jarowit Adam Piotrowski

Parwis Massoudy

Heinz Jakob

Markus Kamler

Payam Akhyari

Matthias Thielmann

Affiliations

Soon will be listed here.

Abstract

: Coronary artery bypass surgery (CABG) with multiple arterial grafting (MAG) has shown potential to improve patient survival compared to single arterial bypass grafting. Whether this superiority in survival also exists in diabetics is uncertain. We therefore aimed to compare short and long-term outcomes of MAG in diabetic versus non-diabetic patients. : In this retrospective study, we investigated short- and long-term clinical outcomes of diabetic ( = 256) and non-diabetic ( = 800) patients undergoing CABG with MAG between January 1999 and December 2019 at our institution. : Diabetics had a significantly higher EuroScore II (1.37 ± 2.4 vs. 0.88 ± 1.58, < 0.0001) and underwent significantly less bilateral internal thoracic artery (BITA) grafting (51.95% vs. 67.75%; < 0.0001) compared to non-diabetics. The incidence of postoperative adverse events, such as pneumonia, stroke, and sepsis, did not differ between the two groups. However, diabetics suffered significantly more often from post-cardiotomy cardiogenic shock, renal failure requiring dialysis, and sternal wound infections over the entire follow-up period. Non-diabetics had a significantly higher median survival time of 19.6 years compared to 14.54 years found in diabetic patients ( < 0.0001). : Among patients undergoing MAG, diabetic individuals were found to have a significantly lower overall median survival. This emphasizes the importance of diabetes as a risk factor in choosing individual surgical strategies.

References

Kapur A, Hall R, Malik I, Qureshi A, Butts J, de Belder M . Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol. 2010; 55(5):432-40. DOI: 10.1016/j.jacc.2009.10.014. View

Benedetto U, Amrani M, Raja S . Guidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups. J Thorac Cardiovasc Surg. 2014; 148(6):2706-11. DOI: 10.1016/j.jtcvs.2014.07.088. View

Barsness G, Peterson E, Ohman E, Nelson C, DeLong E, Reves J . Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation. 1997; 96(8):2551-6. DOI: 10.1161/01.cir.96.8.2551. View

Loop F, Lytle B, Cosgrove D, Stewart R, Goormastic M, Williams G . Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986; 314(1):1-6. DOI: 10.1056/NEJM198601023140101. View

Taggart D, Audisio K, Gerry S, Robinson N, Rahouma M, Soletti G . Single versus multiple arterial grafting in diabetic patients at 10 years: the Arterial Revascularization Trial. Eur Heart J. 2022; 43(44):4644-4652. DOI: 10.1093/eurheartj/ehac199. View

Puskas J, Sadiq A, Vassiliades T, Kilgo P, Lattouf O . Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients. Ann Thorac Surg. 2012; 94(3):710-5. DOI: 10.1016/j.athoracsur.2012.03.082. View

Carson J, Scholz P, Chen A, Peterson E, Gold J, Schneider S . Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002; 40(3):418-23. DOI: 10.1016/s0735-1097(02)01969-1. View

Detre K, Lombardero M, Brooks M, Hardison R, Holubkov R, Sopko G . The effect of previous coronary-artery bypass surgery on the prognosis of patients with diabetes who have acute myocardial infarction. Bypass Angioplasty Revascularization Investigation Investigators. N Engl J Med. 2000; 342(14):989-97. DOI: 10.1056/NEJM200004063421401. View

Kieser T, Lewin A, Graham M, Martin B, Galbraith P, Rabi D . Outcomes associated with bilateral internal thoracic artery grafting: the importance of age. Ann Thorac Surg. 2011; 92(4):1269-75. DOI: 10.1016/j.athoracsur.2011.05.083. View

10.

Yamaguchi A, Kimura N, Itoh S, Adachi K, Yuri K, Okamura H . Efficacy of multiple arterial coronary bypass grafting in patients with diabetes mellitus. Eur J Cardiothorac Surg. 2016; 50(3):520-7. DOI: 10.1093/ejcts/ezw138. View

11.

Mohr F, Morice M, Kappetein A, Feldman T, Stahle E, Colombo A . Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013; 381(9867):629-38. DOI: 10.1016/S0140-6736(13)60141-5. View

12.

Mack M, Squiers J, Lytle B, DiMaio J, Mohr F . Myocardial Revascularization Surgery: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol. 2021; 78(4):365-383. DOI: 10.1016/j.jacc.2021.04.099. View