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Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?
Ioannis K Toumpoulis1, Constantine E Anagnostopoulos, Sandhya Balaram
1Department of Cardiac Surgery, College of Physicians and Surgeons of Columbia University, St. Luke's-Roosevelt Hospital Center, New York, New York, USA.
Insights
Bilateral internal thoracic artery (BITA) bypass surgery did not significantly improve long-term survival in diabetic patients compared to single internal thoracic artery (SITA) bypass. However, BITA showed improved survival in patients aged 60-69, while SITA was better for those over 79.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Diabetic Patient Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
- The use of bilateral internal thoracic arteries (BITA) versus single internal thoracic artery (SITA) for CABG in diabetic patients is debated.
- Long-term survival differences between BITA and SITA in diabetic populations require further investigation.
Purpose of the Study:
- To compare the long-term survival rates of diabetic patients undergoing BITA versus SITA coronary artery bypass surgery.
- To identify potential age-related differences in survival outcomes between BITA and SITA grafting in diabetic patients.
Main Methods:
- A retrospective study matched 980 diabetic patients (490 BITA, 490 SITA) who underwent CABG between 1992 and 2002.
- Propensity score matching was used to control for baseline differences between groups.
- Long-term survival data were collected via the National Death Index with a mean follow-up of 4.7 years.
Main Results:
- Overall, BITA grafting showed no significant impact on long-term survival compared to SITA (HR 0.89, p=0.343).
- No significant differences in 30-day mortality or major postoperative complications were observed.
- Five-year survival rates were similar overall (79.9% BITA vs. 75.7% SITA), but varied by age group: improved for 60-69 year olds with BITA (84.1% vs. 71.0%), and worse for those over 79 (43.1% vs. 70.0%).
Conclusions:
- BITA coronary artery bypass grafting does not significantly affect long-term survival in the general diabetic patient population.
- BITA grafting may offer a survival benefit for diabetic patients aged 60 to 69 years.
- SITA grafting may be more beneficial for diabetic patients older than 79 years.
Background:
The purpose of the present study was to determine whether long-term survival in diabetic patients increased after bilateral internal thoracic artery (BITA) coronary bypass compared with matched patients with single internal thoracic artery (SITA) coronary bypass.
Methods:
The propensity for BITA was determined using logistic regression analysis and each BITA patient was matched with one SITA patient. Between January 1992 and March 2002, 980 matched diabetic patients (490 BITA versus 490 SITA) underwent coronary artery bypass surgery. Long-term survival data were obtained from the National Death Index (mean follow-up, 4.7 +/- 3.0 years). Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots.
Results:
Multivariate Cox regression analysis determined that BITA grafting had no significant effect on long-term survival (hazard ratio 0.89, 95% confidence interval: 0.69 to 1.14, p = 0.343). There were no differences in 30-day mortality (3.9% for BITA versus 3.7%, p = 0.999) and major postoperative complications except for length of stay (11.4 days for BITA versus 12.7 days, p < 0.001). Five-year survival rate was 79.9% in the BITA group and 75.7% in the SITA group (p = 0.252). There was no difference in 5-year survival rate between matched patients younger than 60 or from 70 to 79 years old. However, BITA patients aged 60 to 69 years had better 5-year survival rates (84.1% versus 71.0%, p = 0.0196), whereas the opposite was observed in patients aged more than 79 years (5-year survival for BITA 43.1% versus 70.0%, p = 0.016).
Conclusions:
Bilateral internal thoracic artery grafting had no significant effect on long-term survival for diabetic patients, but it may increase long-term survival in patients aged 60 to 69 years, whereas SITA grafting may be beneficial for patients more than 79 years old.
