TY - JOUR
T1 - On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the bypass angioplasty revascularization investigation 2 diabetes trial
AU - Singh, Ashima
AU - Schaff, Hartzell V.
AU - Mori Brooks, Maria
AU - Hlatky, Mark A.
AU - Wisniewski, Stephen R.
AU - Frye, Robert L.
AU - Sako, Edward Y.
N1 - Publisher Copyright:
© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - OBJECTIVES: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS: On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS: Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.
AB - OBJECTIVES: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS: On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS: Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.
KW - Coronary arteries bypass graft
KW - Diabetic patients
KW - Off-pump procedure
UR - http://www.scopus.com/inward/record.url?scp=84959894500&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84959894500&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezv170
DO - 10.1093/ejcts/ezv170
M3 - Article
C2 - 25968885
AN - SCOPUS:84959894500
SN - 1010-7940
VL - 49
SP - 406
EP - 416
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 2
M1 - ezv170
ER -