Cardiac Surgery/Hybrid Revascularization
Is On-Pump Coronary Artery Bypass Associated With Better Outcome in Patients With Diabetes?
Yi-Tsang Fu1, Hao-Chih Chang1, Shih-Hsien Sung1
Taipei Veterans General Hospital, Taiwan1
The clinical benefits of on-pump coronary artery bypass graft (CABG) surgery remained rebated in diabetic patients with multi-vessel diseases. Therefore, we aim to investigate whether the survival benefit of on-pump CABG surgery differs between patients with and without diabetes.
Consecutive patients undergone CABG surgery from January 2000 to December 2014 at a tertiary medical center were recruited. Patients who underwent emergent CABG surgery or concomitant valvular surgery were excluded. The primary outcomes were defined as all-cause mortality at 30 days and 1 year after the CABG surgery.
A total of 1635 patients (68.3±11.3 years, 81.1% men, 41%diabetes) were enrolled, and 80.8% of them underwent on-pump CABG surgery. Patients undergoing on-pump CABG were younger and had fewer comorbidities of CKD than those having off-pump CABG. There was no significant difference in 30-day mortality between on-pump and off-pump CABG surgery both in diabetic (4.9% vs 8.1%; P= 0.17) and non-diabetic patients(8.4% vs 10.5%; P= 0.35). However, on-pump CABG surgery was associated with a significantly lower 1-year mortality in patients without diabetes (hazard ratio and 95% confidence intervals: 0.60, 0.42-0.87) after adjusting for age, sex, and comorbidities. In contrast, the 1-year survival rates between on-pump and off-pump CABG surgery were similar in patients with diabetes.
The clinical advantage of on-pump over off-pump CABG surgery was observed in patients without diabetes rather than those with diabetes. Comorbidity with diabetes or not should be considered when determining the ways of CABG surgery.