TY - JOUR
T1 - Off-pump versus on-pump coronary artery bypass surgery in patients with actively treated diabetes and multivessel coronary disease
AU - Benedetto, Umberto
AU - Caputo, Massimo
AU - Vohra, Hunaid
AU - Davies, Alan
AU - Hillier, James
AU - Bryan, Alan
AU - Angelini, Gianni D.
PY - 2016/11
Y1 - 2016/11
N2 - ObjectivesWe conducted a
single-center analysis on short-term outcomes and long-term survival in
actively treated diabetic patients undergoing off-pump coronary artery
bypass versus on-pump coronary artery bypass surgery.MethodsThe
final population consisted of 2450 patients with actively treated
diabetes (mean age, 66 ± 9 years; female/male 545/1905, 22%). Of those,
1493 subjects were orally treated and 1011 subjects were taking insulin.
Off-pump coronary artery bypass and on-pump coronary artery bypass were
performed in 1253 and 1197 patients, respectively. Propensity score
matching was used to compare the 2 matched groups.ResultsWhen
compared with on-pump coronary artery bypass, off-pump coronary artery
bypass was associated with a significant risk reduction for
postoperative cerebrovascular accident (odds ratio, 0.49; 95% confidence
interval [CI], 0.25-0.99; P = .04), need for postoperative intra-aortic balloon pump (odds ratio, 0.48; 95% CI, 0.30-0.77; P = .002), and reexploration for bleeding (odds ratio, 0.55; 95% CI, 0.33-0.94; P = .02). Off-pump coronary artery bypass did not significantly affect early (hazard ratio [HR], 1.32; 95% CI, 0.73-2.40; P = .36) and late (HR, 1.08; 95% CI, 0.92-1.28; P = .32)
mortality. However, off-pump coronary artery bypass with incomplete
revascularization was associated with reduced survival when compared
with off-pump coronary artery bypass with complete revascularization
(HR, 1.82; 95% CI, 1.34-2.46; P = .0002) and on-pump coronary artery bypass with complete revascularization (HR, 1.83; 95% CI, 1.36-2.47; P < .0001).ConclusionsOff-pump
coronary artery bypass is a safe and feasible option for diabetic
patients with multivessel disease, reduces the incidence of early
complications including postoperative cerebrovascular events, and
provides excellent long-term survival similar to on-pump coronary artery
bypass surgery in case of complete revascularization.
AB - ObjectivesWe conducted a
single-center analysis on short-term outcomes and long-term survival in
actively treated diabetic patients undergoing off-pump coronary artery
bypass versus on-pump coronary artery bypass surgery.MethodsThe
final population consisted of 2450 patients with actively treated
diabetes (mean age, 66 ± 9 years; female/male 545/1905, 22%). Of those,
1493 subjects were orally treated and 1011 subjects were taking insulin.
Off-pump coronary artery bypass and on-pump coronary artery bypass were
performed in 1253 and 1197 patients, respectively. Propensity score
matching was used to compare the 2 matched groups.ResultsWhen
compared with on-pump coronary artery bypass, off-pump coronary artery
bypass was associated with a significant risk reduction for
postoperative cerebrovascular accident (odds ratio, 0.49; 95% confidence
interval [CI], 0.25-0.99; P = .04), need for postoperative intra-aortic balloon pump (odds ratio, 0.48; 95% CI, 0.30-0.77; P = .002), and reexploration for bleeding (odds ratio, 0.55; 95% CI, 0.33-0.94; P = .02). Off-pump coronary artery bypass did not significantly affect early (hazard ratio [HR], 1.32; 95% CI, 0.73-2.40; P = .36) and late (HR, 1.08; 95% CI, 0.92-1.28; P = .32)
mortality. However, off-pump coronary artery bypass with incomplete
revascularization was associated with reduced survival when compared
with off-pump coronary artery bypass with complete revascularization
(HR, 1.82; 95% CI, 1.34-2.46; P = .0002) and on-pump coronary artery bypass with complete revascularization (HR, 1.83; 95% CI, 1.36-2.47; P < .0001).ConclusionsOff-pump
coronary artery bypass is a safe and feasible option for diabetic
patients with multivessel disease, reduces the incidence of early
complications including postoperative cerebrovascular events, and
provides excellent long-term survival similar to on-pump coronary artery
bypass surgery in case of complete revascularization.
U2 - 10.1016/j.jtcvs.2016.06.038
DO - 10.1016/j.jtcvs.2016.06.038
M3 - Article (Academic Journal)
C2 - 27496617
VL - 152
SP - 1321
EP - 1330
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 5
ER -