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Eur J Cardiothorac Surg 2005;27:281-288
© 2005 Elsevier Science NL

Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting

^a Research Center, Montreal Heart Institute, Montreal, Que., Canada
^b Department of Surgery, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Que., Canada H1T 1C8

Received 6 September 2004; received in revised form 18 October 2004; accepted 27 October 2004.

^* Corresponding author. Address: Department of Surgery, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Que., Canada H1T 1C8. Tel.: +1 514 376 3330x3715; fax: +1 514 376 1355. (E-mail: michel.carrier{at}icm-mhi.org).

Objective: Diabetes mellitus is a major independent risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). The aim of this study was to assess the effect of bilateral (B) internal thoracic artery grafting (ITA) in diabetic patients with multivessel CABG. Methods: Between 1985 and 1995, 4382 patients underwent primary isolated multivessel CABG with ITA grafting and concomitant saphenous vein grafting (SVG). Outcome of diabetic and nondiabetic patients undergoing single (S) ITA+SVG (n=419 and 2079) and BITA+SVG (n=214 and 1594) grafting was obtained at a mean follow-up of 11±3 years. Results: Diabetic patients were older, included more women, and had more obesity, hypertension and peripheral vascular disease than nondiabetic patients. Deep sternal wound infection rate was 1.9% for diabetic patients vs 1.2% for nondiabetic patients (P=0.2) and 30-day mortality was 1.7 vs 1.8% (P=0.9). Cox regression analysis with interaction term and propensity scoring showed that BITA grafting decreased the risk of death (Hazard Ratio=0.72 [0.57–0.91, 95%CI]) and coronary reoperation (HR=0.38 [0.19–0.77]) in both diabetic and nondiabetic patients, with no significant interaction noted. BITA grafting decreased the risk of myocardial infarction at long-term follow-up in nondiabetic patients (HR=0.72 [0.60–0.86]) but not in diabetic patients. Ten-year freedom rate from myocardial infarction in diabetic patients was 80 and 76% for SITA and BITA grafting patients, respectively. However, survival following myocardial infarction was better for patients who underwent BITA grafting, in both diabetic and nondiabetic subgroups. Conclusions: BITA+SVG grafting in diabetic patients improves survival and decrease coronary reoperation compared with SITA+SVG at long-term follow-up. Survival following myocardial infarction is improved with BITA grafting.

Key Words: Coronary artery bypass • Diabetes • Internal thoracic arteries • Long-term follow-up • Myocardial infarction

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