Improved graft patency rates and mid-term outcome of diabetic patients undergoing total arterial myocardial revascularization

Overview

Objectives. Diabetes negatively affects the outcome of patients undergoing percutaneous
transluminal coronary angioplasty (PTCA) or coronary surgery. However, data are lacking
with respect to the impact of arterial revascularization in the diabetic population.
Methods. Between 1999 and 2003, 100 of 491 diabetics underwent coronary artery bypass graft
surgery (CABG) with total arterial grafting (Group 1, G1); these patients were compared with 100
diabetics undergoing conventional CABG with saphenous veins (Group 2, G2), who were
matched for Euroscore and other risk factors such as age, obesity, hypertension, left ventricular
ejection fraction (LVEF), previous myocardial infarction and chronic obstructive pulmonary disease
(COPD).
Results. Both groups had a similar number of diseased coronary vessels (G1=2.6 vs G2= 2.7)
and received a similar degree of myocardial revascularization (grafted vessels: G1=2.2 vs
G2=2.4). Early outcome was comparable between the groups in terms of ventilatory support
(G1=10.8±6 vs G2=10.4±5 hours), intensive care unit (ICU) stay (G1=24±12 vs G2=25±14 hours)
and major post-operative complications such as atrial fibrillation (G1=26% vs G2=28%), peri-operative
myocardial infarction (G1=1% vs G2=2%)and prolonged ventilatory support (G1=6% vs
G2=5%). Hospital mortality was 2% in G1 and 3% in G2. Angiography was performed at a mean
follow-up of 34 months in 65.9% and 71.1% of hospital survivors of G1 and G2 respectively: patients
of G1 showed a significantly higher patency rate (G1=96% vs G2=83.6%, p=0.02). Additionally,
patients of G1 showed a significantly lower incidence of recurrent myocardial ischemia
(G1=7 pts. vs G2=18 pts., p=0.03), late myocardial infarction (G1=2 pts. vs G2=10 pts., p=0.03)
and need for coronary reintervention (G1=1 pt. vs G2=12 pts, p=0.004).
Conclusions. Total arterial grafting in diabetic patients significantly improved the benefits of
coronary surgery providing at mid term a higher graft patency rate with a lower incidence of cardiac
related events. (Heart International 2006; 3-4: 136-40)

Keywords

Coronary surgery, Diabetes, Arterial conduits, Composite grafts

Correspondence

Claudio Muneretto, MD, UDA Cardiochirurgia – Spedali Civili, P.le Spedali Civili, 1, 25123 Brescia – Italy, munerett@med.unibs.it