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 - Funding Information:
The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) is funded by the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases (U01 HL061744, U01 HL061746, U01 HL061748, U01 HL063804, R21HL121495). BARI 2D receives significant supplemental funding provided by GlaxoSmithKline, Collegeville, PA; Lantheus Medical Imaging, Inc. (formerly Bristol-Myers Squibb Medical Imaging, Inc.), North Billerica, MA; Astellas Pharma US, Inc., Deerfield, IL; Merck & Co., Inc., Whitehouse Station, NJ; Abbott Laboratories, Inc., Abbott Park, IL and Pfizer, Inc., New York, NY. Generous support is given by Abbott Laboratories Ltd., MediSense Products, Mississauga, Canada; Bayer Diagnostics, Tarrytown, NY; Becton, Dickinson and Company, Franklin Lakes, NJ; J. R. Carlson Labs, Arlington Hts., IL; Centocor, Inc., Malvern, PA; Eli Lilly and Company, Indianapolis, IN; LipoScience, Inc., Raleigh, NC; Merck Sante, Lyon, France; Novartis Pharmaceuticals Corporation, East Hanover, NJ and Novo Nordisk, Inc., Princeton, NJ. Conflict of interest: Robert L. Frye was the Study Chair, Maria Mori Brooks was the Co-Principal Investigator of the Coordinating Center, Mark A. Hlatky was the Principal Investigator of the Economics Core Laboratory and Edward Y. Sako was the Chair of the Surgery Working Group of the BARI 2D study.
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
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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 -