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Improving long term outcome for diabetic patients undergoing surgical revascularization by use of the radial artery
Darryl M Hoffman1, Kamellia R Dimitrova, Helbert Decastro
1Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, NY 10003, USA. Dhoffman@chpnet.org
Insights
For diabetic patients undergoing coronary artery bypass grafting (CABG), using the radial artery (RA) alongside the left internal thoracic artery (LITA) significantly improves long-term survival compared to using only LITA and saphenous vein grafts. This strategy redefines optimal revascularization for diabetic patients with multi-vessel disease.
Area of Science:
- Cardiovascular Surgery
- Diabetic Complications
- Vascular Grafting
Background:
- Diabetes mellitus is associated with poorer outcomes following coronary artery bypass grafting (CABG).
- The use of arterial conduits, such as the radial artery (RA), is increasingly explored to improve surgical results.
Purpose of the Study:
- To evaluate the long-term survival benefit of using radial artery (RA) conduits in diabetic patients undergoing CABG, in addition to the left internal thoracic artery (LITA) and potentially saphenous vein (SV).
- To compare outcomes between diabetic patients receiving LITA + RA +/- SV versus those receiving LITA + SV only.
Main Methods:
- A propensity-matched analysis of long-term survival was conducted on diabetic patients who underwent isolated, first-time CABG between January 1995 and June 2010.
- Data included 409 matched pairs comparing the LITA + RA +/- SV group with the LITA + SV only group, with all-cause mortality as the primary endpoint.
Main Results:
- Operative (30-day) mortality was significantly lower in the RA group (0.1%) compared to the SV group (1.9%).
- Propensity-matched analysis showed reduced mortality in the RA group (0.25%) versus the SV group (0.5%).
- Kaplan-Meier survival at 12 years was notably higher for the RA group (70%) than the SV group (59%), with RA use being a significant predictor of better survival (HR 0.683, p=0.0122).
Conclusions:
- The use of radial artery conduits in diabetic patients undergoing CABG with LITA provides a substantial and sustained survival advantage over LITA and vein grafts.
- This finding redefines optimal revascularization strategies for diabetic patients with multi-vessel coronary artery disease.
Background:
Diabetes predicts worse outcomes after coronary artery bypass grafting (CABG) We hypothesized that a strategy using radial artery (RA) conduit(s) would improve outcomes and long term survival for diabetic patients undergoing CABG with Left Internal Thoracic Artery (LITA) and RA grafts, with or without additional saphenous vein (SV) when compared with outcomes for patients bypassed with LITA and SV but no RA.
Methods:
A propensity matched study of long term survival in diabetic patients who had isolated first time CABG from January 1995 to June 2010 at an urban academic medical center in New York City. Our primary endpoint was all cause mortality determined from the Social Security Death Index in December 2010.
Results:
We compared our 15 year outcomes in diabetic patients after isolated, primary CABG: 642 patients received LITA + RA +/- SV (RA group) vs. 1201 patients who had LITA + SV only (SV group). Propensity scoring for multiple preoperative and operative variables matched 409 patients from each group: 68% were male with an average age of 61 years and ejection fraction averaged 47%. Average grafts per patient was 3.7 for both groups with 2.3 arterial grafts per patient for the RA group. Operative (30 day) mortality was 0.1% RA vs. 1.9% SV, (p<0.0001) For propensity matched patients, mortality was 0.25 RA vs 0.5% SV. (p<0.001) The incidence of major complications was similar in both groups. Kaplan Meier actuarial survival at 1, 5, 10 and 12 years was 98%, 89%, 77 and 70% for RA vs. 96%, 87%, 64% and 59% for SV (p<0.006.) By Cox multivariate analysis significant predictors of mortality were: age, stroke, peripheral vascular disease, COPD, creatinine > 2.5mg/dl and low ejection fraction but only RA use predicted better survival [HR 0.683, CI 0.507- 0.920, p=0.0122].
Conclusion:
For diabetic patients having CABG with LITA, use of radial artery conduit adds a substantial and sustained survival advantage compared to LITA and vein. Optimal revascularization for diabetics with multi vessel disease is redefined.
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