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Meta-analysis of BITA versus SITA grafting in diabetic patients: evidence from propensity score-matched studies
John Nolan1, Audrey Rachel Wijaya2, I Komang Adhi Parama Harta3
1Faculty of Medicine, Udayana University, Denpasar, Indonesia. johnnolan@student.unud.ac.id.
Insights
Bilateral internal thoracic artery (BITA) grafting improves long-term survival in diabetic patients undergoing coronary artery bypass grafting (CABG) compared to single internal thoracic artery (SITA) grafting. However, BITA grafting increases the risk of deep sternal wound infection.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) is linked to improved long-term survival versus single internal thoracic artery (SITA) grafts.
- Optimal CABG technique for diabetic patients remains unclear.
- This meta-analysis evaluates BITA vs. SITA CABG in diabetic populations.
Purpose of the Study:
- To compare the effectiveness and safety of BITA and SITA CABG in diabetic patients.
- To analyze mid- to long-term mortality rates.
- To assess risks including deep sternal wound infection and reoperation for hemorrhage.
Main Methods:
- Propensity score-matched studies were identified via comprehensive literature searches.
- Databases searched included Google Scholar, Science Direct, and PubMed.
- Meta-analysis included 11 studies with 3762 diabetic patients.
Main Results:
- BITA grafting significantly reduced long-term mortality compared to SITA grafting (HR 0.78; P=0.03).
- No significant differences were observed in 30-day mortality, reoperation for bleeding, stroke, or renal failure.
- BITA grafting was associated with an increased risk of deep sternal wound infection.
Conclusions:
- BITA grafting offers superior overall survival for diabetic patients undergoing CABG.
- Increased risk of deep sternal wound infection is a consideration with BITA grafting.
- Findings aid in selecting CABG grafting techniques for diabetic patients.
Background:
It has been demonstrated that the use of bilateral internal thoracic artery (BITA) grafting in coronary artery bypass grafting (CABG) improves long-term survival in comparison to the use of a single internal thoracic artery (SITA) graft. However, the optimal transplantation technique for diabetic patients remains undetermined. The purpose of this meta-analysis was to compare the effectiveness and safety of BITA and SITA CABG in diabetic patients.
Methods:
A comprehensive search of Google Scholar, Science Direct, and PubMed was conducted for studies with propensity score-matched comparing between BITA and SITA grafting in diabetic patients. The main goal was to know mid- to long-term mortality, and the supplementary results included incidence of deep sternal wound infection, 30-day mortality, and incidence of reoperation due to hemorrhage.
Results:
The meta-analysis included 11 studies involving 3762 diabetic patients with matched propensity scores. Compared to SITA grafting, BITA grafting was associated with a significant reduction in long-term mortality (HR 0.78; 95% CI 0.67-0.91), P = 0.03, I2 = 54%. There were no significant differences between the two groups in terms of 30-day mortality, reoperation for bleeding, cerebrovascular accident, or renal failure.
Conclusions:
BITA grafting appears to provide better overall survival than SITA grafting in patients with diabetes. However, using BITA grafting is associated with a greater risk of deep sternal wound infection. These findings may help guide the choice of grafting technique in diabetic patients undergoing CABG.
