Acquired: Coronary
Off-pump versus on-pump coronary artery bypass surgery in patients with actively treated diabetes and multivessel coronary disease

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Abstract

Objectives

We conducted a single-center analysis on short-term outcomes and long-term survival in actively treated diabetic patients undergoing off-pump coronary artery bypass versus on-pump coronary artery bypass surgery.

Methods

The final population consisted of 2450 patients with actively treated diabetes (mean age, 66 ± 9 years; female/male 545/1905, 22%). Of those, 1493 subjects were orally treated and 1011 subjects were taking insulin. Off-pump coronary artery bypass and on-pump coronary artery bypass were performed in 1253 and 1197 patients, respectively. Propensity score matching was used to compare the 2 matched groups.

Results

When compared with on-pump coronary artery bypass, off-pump coronary artery bypass was associated with a significant risk reduction for postoperative cerebrovascular accident (odds ratio, 0.49; 95% confidence interval [CI], 0.25-0.99; P = .04), need for postoperative intra-aortic balloon pump (odds ratio, 0.48; 95% CI, 0.30-0.77; P = .002), and reexploration for bleeding (odds ratio, 0.55; 95% CI, 0.33-0.94; P = .02). Off-pump coronary artery bypass did not significantly affect early (hazard ratio [HR], 1.32; 95% CI, 0.73-2.40; P = .36) and late (HR, 1.08; 95% CI, 0.92-1.28; P = .32) mortality. However, off-pump coronary artery bypass with incomplete revascularization was associated with reduced survival when compared with off-pump coronary artery bypass with complete revascularization (HR, 1.82; 95% CI, 1.34-2.46; P = .0002) and on-pump coronary artery bypass with complete revascularization (HR, 1.83; 95% CI, 1.36-2.47; P < .0001).

Conclusions

Off-pump coronary artery bypass is a safe and feasible option for diabetic patients with multivessel disease, reduces the incidence of early complications including postoperative cerebrovascular events, and provides excellent long-term survival similar to on-pump coronary artery bypass surgery in case of complete revascularization.

Key Words

off-pump coronary artery bypass grafting
diabetes mellitus
survival

Abbreviations and Acronyms

CABG
coronary artery bypass grafting
CI
confidence interval
CVA
cerebrovascular accident
DM
diabetes mellitus
euroSCORE
European System for Cardiac Operative Risk Evaluation
HR
hazard ratio
IR
incomplete revascularization
IABP
intra-aortic balloon pump
ONCAB
on-pump coronary artery bypass
OPCAB
off-pump coronary artery bypass
VIF
variance inflation factor

Cited by (0)

This study was supported by the British Heart Foundation and the NIHR, Bristol Cardiovascular Biomedical Research Unit.