Should Bilateral Internal Thoracic Artery Grafting Be Used in Patients With Diabetes Mellitus?

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• 作者：Dmitry Pevni ; MD^a ; ^&lowast ; ; ^{pevnid@gmail.com} ; Benjamin Medalion ; MD^b ; ^&lowast ; ; Rephael Mohr ; MD^a ; Yanai Ben-Gal ; MD^a ; Adam Laub ; MD^a ; Avner Nevo ; MD^a ; Amir Kramer ; MD^a ; Yosef Paz ; MD^a ; Nachum Nesher ; MD^a
• 关键词：BITA ; bilateral internal thoracic artery ; CABG ; coronary artery bypass graft surgery ; CI ; confidence interval ; COPD ; chronic obstructive pulmonary disease ; CVA ; cerebrovascular accident ; EuroSCORE ; European System for Cardiac Operative Risk Evaluation ; IDDM ; insulin-dependent diabetes mellitus ; ITA ; internal thoracic artery ; MI ; myocardial infarction ; OR ; odds ratio ; PCI ; percutaneous coronary intervention ; PVD ; peripheral vascular disease ; SITA ; single internal thoracic artery
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：103
• 期：2
• 页码：551-558
• 全文大小：521 K
• 卷排序：103

文摘

Bilateral internal thoracic artery (BITA) grafting in patients with diabetes mellitus is controversial because of a higher risk for sternal infection. The purpose of this study is to compare the outcome of BITA grafting to that of single ITA (SITA) grafting in patients with diabetes.MethodsBetween 1996 and 2010, 964 diabetic patients with multivessel disease who underwent primary coronary artery bypass graft surgery with BITA were compared with 564 patients who underwent coronary artery bypass graft surgery with SITA and saphenous vein grafts.ResultsThe SITA patients were older, more often female, more likely to have chronic obstructive pulmonary disease, ejection fraction 30% or less, insulin-dependent diabetes, recent myocardial infarction, renal insufficiency, peripheral vascular disease, and emergency operation. The BITA patients more often underwent coronary artery bypass graft surgery with three or more grafts. The two groups had similar operative mortality, 2.6% BITA versus 3.0% SITA, and sternal infection, 3.1% versus 3.9%, respectively. The mean follow-up was 12.2 ± 4.3 years. Unadjusted Kaplan-Meier 10-year survival of the BITA group was better than that of the SITA group (65.3% ± 3.1% versus 55.5% ± 4.5%, respectively; p = 0.004), After propensity score matching (490 well-matched pairs), Kaplan-Meier 10-year survival was not significantly different between the matched groups; however, the Cox-adjusted survival of the BITA patients was better (hazard ratio 0.729, 95% confidence interval: 0.551 to 0.964, p = 0.027).ConclusionsThe findings of this large cohort study suggest that the long-term outcome of patients with diabetes and multivessel disease who undergo BITA grafting is better than that of diabetic patients who undergo coronary artery bypass graft surgery with SITA and saphenous vein grafts.