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Total Arterial Revascularization: A Superior Strategy for Diabetic Patients Who Require Coronary Surgery

James Tatoulis1, Rochelle Wynne2, Peter D Skillington1

  • 1Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia.

The Annals of Thoracic Surgery
|July 19, 2016
PubMed

Insights

Total arterial revascularization (TAR) offers diabetic patients undergoing coronary artery bypass graft surgery (CABG) improved long-term survival. This approach showed a survival advantage for diabetic patients with no increase in perioperative mortality.

Area of Science:

  • Cardiovascular Surgery
  • Diabetic Cardiopathy
  • Surgical Outcomes

Background:

  • Coronary artery bypass graft surgery (CABG) is superior to percutaneous intervention for diabetic patients with advanced coronary artery disease.
  • Investigated the survival benefit of total arterial revascularization (TAR) in diabetic patients undergoing CABG.

Purpose of the Study:

  • To determine if total arterial revascularization (TAR) provides an additional survival advantage for diabetic patients undergoing coronary artery bypass graft surgery (CABG).

Main Methods:

  • A retrospective analysis of 63,592 cases from an Australian cardiac surgical database.
  • Identified 11,642 diabetic patients undergoing first-time isolated CABG between 2001 and 2012.
  • Used propensity matching to create 6,232 pairs of diabetic patients who did or did not receive TAR, linking data to the National Death Index.

Main Results:

  • Perioperative mortality was similar between TAR and non-TAR groups (1.2% vs. 1.4%, p=0.506).
  • Late mortality was significantly lower in the TAR group (10.2%) compared to the non-TAR group (12.2%, p=0.041).
  • Kaplan-Meier survival at 1, 5, and 10 years was higher for the TAR group (96.2%, 88.9%, 82.2%) versus non-TAR (95.4%, 87.5%, 78.3%; log rank, p=0.036).

Conclusions:

  • Total arterial revascularization (TAR) offers a significant long-term survival benefit for diabetic patients undergoing CABG.
  • This benefit is achieved with equivalent perioperative mortality rates compared to non-TAR approaches.
  • TAR should be considered for diabetic patients requiring CABG to improve long-term prognostic outcomes.
Abstract

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