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On-Pump or Off-Pump Impact of Diabetic Patient Undergoing Coronary Artery Bypass Grafting 5-Year Clinical Outcomes
Fei Xu1, Lei Li2, Chenghui Zhou1
1Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Insights
For diabetic patients undergoing coronary artery bypass grafting (CABG), off-pump surgery showed a lower five-year mortality rate and reduced risks of stroke and atrial fibrillation compared to on-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Diabetic Patient Management
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) in diabetic patients presents a choice between off-pump and on-pump techniques.
- The optimal surgical approach remains a subject of ongoing clinical debate.
Purpose of the Study:
- To compare the mid-term and long-term clinical outcomes of off-pump versus on-pump CABG in diabetic patients.
- To evaluate the impact of surgical approach on survival rates and postoperative complications.
Main Methods:
- Retrospective analysis of 1269 diabetic patients undergoing primary isolated CABG (2013-2015).
- Comparison of hospitalization outcomes using logistic regression.
- Survival analysis using Kaplan-Meier curves and Cox proportional-hazard models.
- Propensity-score matching (PSM) for robust comparison between off-pump (614 patients) and on-pump (655 patients) groups.
Main Results:
- Five-year all-cause mortality was significantly lower in the off-pump group (4.23%) compared to the on-pump group (5.95%, p=0.044).
- Off-pump CABG was associated with a reduced incidence of postoperative stroke and atrial fibrillation.
Conclusions:
- Off-pump CABG procedures demonstrate potential advantages for diabetic patients undergoing this surgery.
- The findings suggest that an off-pump approach may be a preferable strategy for improving survival and reducing complications in this patient population.
Background:
For diabetic patients undergoing coronary artery bypass grafting (CABG), there is still a debate about whether an off-pump or on-pump approach is advantageous.
Methods:
A retrospective review of 1269 consecutive diabetic patients undergoing isolated, primary CABG surgery from January 1, 2013 to December 31, 2015 was conducted. Among them, 614 received non-cardiopulmonary bypass treatment during their operation (off-pump group), and 655 received cardiopulmonary bypass treatment (on-pump group). The hospitalization outcomes were compared by multiple logistic regression models with patient characteristics and operative variables as independent variables. Kaplan-Meier curves and Cox proportional-hazard regression models for mid-term (2-year) and long-term (5-year) clinical survival analyses were used to determine the effect on survival after CABG surgery. In order to further verify the reliability of the results, propensity-score matching (PSM) was also performed between the two groups.
Results:
Five-year all-cause death rates were 4.23% off-pump vs. 5.95% on-pump (p = 0.044), and off-pump was associated with reduced postoperative stroke and atrial fibrillation.
Conclusions:
These findings suggest that off-pump procedures may have benefits for diabetic patients in CABG.
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