Bilateral Internal Thoracic Artery Grafting Improves Survival for Severe Left Ventricular Dysfunction and Diabetes.

Abstract

BACKGROUND:

In patients with severe left ventricular (LV) dysfunction requiring coronary artery bypass grafting (CABG), the association between diabetic status and outcomes after surgery, as well as with survival benefit following bilateral internal thoracic artery (ITA) grafting, remain largely unknown.Methods and Results:Patients (n=188; mean [±SD] age 67±9 years) with LV ejection fraction ≤40% who underwent isolated initial CABG were classified into non-diabetic (n=64), non-insulin-dependent diabetic (NIDM; n=74), and insulin-dependent diabetic (IDM; n=50) groups. During follow-up (mean [±SD] 68±47 months), the 5-year survival rate was 84% and 65% among non-diabetic and diabetic patients, respectively (P=0.034). After adjusting for all covariates, both NIDM and IDM were associated with increased mortality, with hazard ratios (HRs) of 1.9 (95% confidence interval [CI] 1.0-3.7; P=0.049) and 2.4 (95% CI 1.2-4.8; P=0.016), respectively. Among non-diabetic patients, there was no difference in the 5-year survival rate between single and bilateral ITA grafting (86% vs. 80%, respectively; P=0.95), whereas bilateral ITA grafting increased survival among diabetic patients (57% vs. 81%; P=0.004). Multivariate analysis revealed that bilateral ITA was significantly associated with a decreased risk of mortality (HR 0.3; 95% CI 0.1-0.8; P=0.024).

CONCLUSIONS:

NIDM and IDM were significantly associated with worse long-term clinical outcome after CABG for severe LV dysfunction. Bilateral ITA grafting has the potential to improve survival in diabetic patients with severe LV dysfunction.

• Authors: Satoshi Kainuma, Koichi Toda, Takashi Daimon, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Daisuke Yoshioka, Takuji Kawamura, Ai Kawamura, Noriyuki Kashiyama, Takayoshi Ueno, Toru Kuratani, Toshihiro Funatsu, Haruhiko Kondoh, Takafumi Masai, Arudo Hiraoka, Taichi Sakaguchi, Hidenori Yoshitaka, Yukitoshi Shirakawa, Toshiki Takahashi, Masayuki Sakaki, Kazuhiro Taniguchi, Yoshiki Sawa, Osaka Cardiovascular Surgery Research (OSCAR) Group
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 85 Issue 11 Pg. 1991-2001 (10 25 2021) ISSN: 1347-4820 [Electronic] Japan
• PMID: 33828021 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Coronary Artery Bypass (methods)
• Coronary Artery Disease (complications, surgery)
• Diabetes Mellitus
• Humans
• Mammary Arteries
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Ventricular Dysfunction, Left (surgery)