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Published on: March 27, 2018
Single Arterial Versus Multiple Arterial Grafting in 3,164 Diabetic Patients Undergoing Coronary Artery Bypass
Albaraa Al-Holy1, Maria Comanici1, Anonna Das1
1Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
Insights
Multiple arterial grafting (MAG) appears safe for diabetic patients undergoing coronary artery bypass grafting (CABG). While short-term outcomes are similar to single arterial grafting (SAG), long-term survival benefits of MAG require further investigation.
Area of Science:
- Cardiovascular Surgery
- Diabetic Complications
- Surgical Outcomes
Background:
- Diabetic patients undergoing coronary artery bypass grafting (CABG) face higher risks.
- Multiple arterial grafting (MAG) is underutilized in this population.
- The comparative safety and efficacy of MAG versus single arterial grafting (SAG) in diabetics is unclear.
Purpose of the Study:
- To evaluate short-term safety and long-term survival of MAG compared to SAG in diabetic CABG patients.
- To assess outcomes using a propensity-matched design.
Main Methods:
- Retrospective single-center study of 3,164 diabetic patients undergoing isolated CABG (1996-2023).
- Graft strategies: SAG (n=2,499) vs. MAG (n=665).
- Propensity score matching created 662 pairs for analysis.
Main Results:
- Unmatched MAG cohort had more grafts and higher deep sternal wound infection (DSWI) rates (3.0% vs 1.7%).
- 30-day mortality was similar between unmatched groups (2.7% vs 2.8%).
- Matched cohort showed no significant differences in short-term outcomes; long-term survival was comparable (p=0.954) up to 20 years.
Conclusions:
- MAG can be safely utilized in diabetic patients undergoing CABG.
- The long-term survival advantage of MAG in this population remains uncertain.
- Age, sex, NYHA class, prior surgery, ventricular function, and disease extent predict mortality.
Abstract:
Diabetic patients undergoing coronary artery bypass grafting (CABG) are at increased risk of adverse outcomes, yet the role of multiple arterial grafting (MAG) remains underutilized and understudied in this population. The objective of this study was to evaluate short-term safety and long-term survival outcomes of MAG compared with single arterial grafting (SAG) in diabetic patients, using a propensity-matched design. This retrospective single center study included 3,164 diabetic patients who underwent isolated CABG between January 1996 and September 2023, stratified by graft strategy: SAG (n = 2,499) and MAG (n = 665). Propensity score matching was applied to balance baseline differences, yielding 662 matched pairs. In the unmatched cohort, MAG was associated with a significantly higher number of grafts and a greater rate of deep sternal wound infection (DSWI) (3.0% vs 1.7%; p = 0.028), while 30-day mortality was comparable (2.7% vs 2.8%; p = 0.939). In the matched cohort, short-term outcomes did not differ significantly between groups (p >0.3 for all). Kaplan-Meier survival estimates showed comparable survival (p = 0.954) at 1 year (92% vs 91%), 5 years (85% vs 83%), 10 years (73% vs 73%), 15 years (57% vs 62%), and 20 years (44% vs 41%). Multivariate Cox regression identified age, female sex, New York Heart Association (NYHA) class, prior cardiac surgery, reduced ventricular function, and disease extent as independent predictors of mortality. In conclusion, these findings suggest that MAG can be safely offered to diabetic patients, though its long-term survival benefit remains uncertain.
