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Updated: Dec 29, 2025
Human Internal Mammary Artery IMA Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis
Published on: May 9, 2012
Does Bilateral Internal Mammary Artery Grafting Better Suit Patients With Diabetes? - Two Different Ways to Explore
Chuan Wang1, Ping Li1, Fan Zhang1
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University.
Insights
Bilateral internal mammary artery (BIMA) grafting offers better long-term survival for diabetic patients undergoing coronary artery bypass grafting (CABG) compared to single internal mammary artery (SIMA). While BIMA shows a slightly increased infection risk, it does not worsen mortality or infection in diabetic patients.
Area of Science:
- Cardiovascular Surgery
- Diabetic Complications
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for heart disease.
- The choice of internal mammary artery graft (single vs. bilateral) can impact outcomes, especially in diabetic patients.
- Diabetic patients often face higher risks for surgical complications.
Purpose of the Study:
- To compare short-term mortality, sternal wound infection (SWI), and long-term survival in diabetic patients undergoing CABG with bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA).
- To evaluate outcomes in diabetic versus non-diabetic patients receiving BIMA grafting.
Main Methods:
- A meta-analysis of nineteen studies involving 21,143 patients.
- Comparison groups included CABG with BIMA vs. SIMA, and diabetic vs. non-diabetic patients undergoing BIMA grafting.
- Outcomes assessed were in-hospital mortality, SWI, and long-term survival.
Main Results:
- BIMA was associated with lower in-hospital mortality (OR 0.73) and higher SWI risk (OR 1.30) compared to SIMA.
- Diabetic patients receiving BIMA did not show significantly higher risks of mortality (OR 1.22) or SWI (OR 1.10) compared to non-diabetic patients.
- BIMA demonstrated significantly higher long-term survival rates than SIMA (HR 0.76).
Conclusions:
- Bilateral internal mammary artery (BIMA) grafting is a preferable option for diabetic patients undergoing coronary artery bypass grafting (CABG), despite a potential increase in infection risk.
- CABG with BIMA offers a significant long-term survival benefit compared to single internal mammary artery (SIMA) grafting.
- Diabetic status does not appear to significantly increase mortality or SWI risks when BIMA is used.
Background:
This analysis compared short-term mortality, sternal wound infection (SWI), and long-term survival outcomes in diabetic patients who underwent coronary artery bypass grafting (CABG) with bilateral (BIMA) vs. single (SIMA) internal mammary artery, as well as in diabetic vs. non-diabetic patients undergoing BIMA grafting.
Methods And Results:
Nineteen studies were included in the study, covering 21,143 different patients. Of these patients, 6,464 underwent CABG with BIMA, 10,264 underwent CAGB with SIMA, 11,584 had diabetes, and 6,717 did not. Compared with SIMA, BIMA had a significantly lower risk of in-hospital mortality (odds ratio [OR] 0.73, P=0.02), but a significantly higher risk of SWI (OR 1.30, P=0.04). However, compared with non-diabetic patients who underwent CABG with BIMA, diabetic patients with BIMA grafting did not have significantly higher risks of either mortality (OR 1.22, P=0.53) or SWI (OR 1.10, P=0.72). No significant differences were detected with different harvesting techniques. Longer term, BIMA was associated with a significantly higher rate of survival than SIMA (hazard ratio [HR] 0.76, P<0.001).
Conclusions:
Results from the 2 types of comparisons indicate that BIMA is a preferable option for diabetic patients, even though it has a higher risk of infection. CABG with BIMA is also associated with a long-term survival benefit.
