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Eur J Cardiothorac Surg. 2016 Feb;49(2):406-16. doi: 10.1093/ejcts/ezv170. Epub 2015 May 11.

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.

Author information

1
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
2
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
3
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
4
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
5
Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA sako@uthscsa.edu.

Abstract

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.

KEYWORDS:

Coronary arteries bypass graft; Diabetic patients; Off-pump procedure

PMID:
25968885
PMCID:
PMC4711702
DOI:
10.1093/ejcts/ezv170
[Indexed for MEDLINE]
Free PMC Article

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