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Arterial revascularization benefits patients with diabetes undergoing CABG
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CABG with total arterial revascularization conferred better long-term mortality in patients with diabetes than conventional CABG, researchers reported.
“Going into this study, we believed that [patients with diabetes] would do better using total arterial techniques,” James Tatoulis, MD, FRACS, from the department of cardiothoracic surgery, Royal Melbourne Hospital, Melbourne, Australia, said in a press release. “But it was gratifying to actually prove it and also to be able to document the significant magnitude of the difference.”
James Tatoulis
Tatoulis and colleagues conducted a retrospective analysis of 34,181 patients from an Australian cardiac surgery database who underwent CABG for the first time between 2001 and 2012.
Among the cohort, 34.1% had diabetes and 35.9% received total arterial revascularization instead of conventional CABG. Of those with diabetes, 32.6% received total arterial revascularization.
Tatoulis and colleagues performed propensity matching to pair 6,232 patients who had total arterial revascularization with 6,232 who had conventional CABG, and they confirmed mortality via the National Death Index.
In the propensity-matched cohort, there were 3,984 patients with diabetes (32%), of whom 2,017 had total arterial revascularization and 1,967 had conventional CABG.
Outcomes of interest included perioperative mortality and late mortality. Mean follow-up was 4.9 years.
Among patients with diabetes in the propensity-matched cohort, perioperative mortality was 1.2% in those who had total arterial revascularization and 1.4% in those who did not (P = .506).
However, Tatoulis and colleagues found, late mortality was 10.2% in the total arterial revascularization group and 12.2% in the non-total arterial revascularization group (P = .041).
Among those with diabetes who had total arterial revascularization, Kaplan-Meier survival rates were 96.2% at 1 year, 88.9% at 5 years and 82.2% at 10 years vs. 95.4% at 1 year, 87.5% at 5 years and 78.3% at 10 years for those with diabetes who had conventional CABG (log-rank P = .036), according to the researchers.
Tatoulis said in the release that only 5% of U.S. patients who require CABG undergo total arterial revascularization. “As a result, there is room for a much larger proportion of patients to have this type of coronary surgery and receive the benefits of a longer life, better quality of life and reduced medical costs,” he said. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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