TY - JOUR
T1 - Bilateral Internal Mammary Artery Use in Diabetic Patients
T2 - Friend or Foe?
AU - Investigators for the Maryland Cardiac Surgery Quality Initiative
AU - Crawford, Todd C.
AU - Zhou, Xun
AU - Fraser, Charles D.
AU - Magruder, J. Trent
AU - Suarez-Pierre, Alejandro
AU - Alejo, Diane
AU - Bobbitt, Jennifer
AU - Fonner, Clifford E.
AU - Wehberg, Kurt
AU - Taylor, Brad
AU - Kwon, Christopher
AU - Fiocco, Michael
AU - Conte, John V.
AU - Salenger, Rawn
AU - Whitman, Glenn J.
N1 - Funding Information:
Dr Zhou is the Hugh R. Sharp, Jr Endowed Cardiac Surgery Research Fellow at the Johns Hopkins University School of Medicine. Dr Fraser is the Irene Piccini Investigator in Cardiac Surgery at Johns Hopkins.
Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/10
Y1 - 2018/10
N2 - Background: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only. Methods: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables. Diabetic BIMA patients were matched 1:1 by nearest neighbor matching to nondiabetic BIMA patients and were separately matched 1:1 to diabetic LIMA patients. We calculated observed-to-expected (O/E) ratios for composite morbidity/mortality, operative mortality, unplanned reoperation, stroke, renal failure, prolonged ventilation, and deep sternal wound infection and compared ratios among matched populations. Results: During the study period, 812 coronary artery bypass grafting patients received BIMA grafts, including 302 patients (37%) with diabetes. We matched 259 diabetic and nondiabetic BIMA patients. O/E ratios were higher in matched diabetic (versus nondiabetic) BIMA patients when comparing composite morbidity/mortality, reoperation, stroke, renal failure, and prolonged ventilation (all O/E ratios >1.0); however, the O/E ratio for operative mortality was higher in nondiabetic BIMA patients. We additionally matched 292 diabetic BIMA to diabetic LIMA patients. Diabetic BIMA patients had a higher O/E ratio for composite morbidity/mortality, operative mortality, stroke, renal failure, and prolonged ventilation. Conclusions: In this statewide analysis, diabetic patients who received BIMA grafts (compared with diabetic patients with LIMA grafts or nondiabetic patients with BIMA grafts) had higher O/E ratios for composite morbidity/mortality as a result of higher O/E ratios for major complications.
AB - Background: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only. Methods: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables. Diabetic BIMA patients were matched 1:1 by nearest neighbor matching to nondiabetic BIMA patients and were separately matched 1:1 to diabetic LIMA patients. We calculated observed-to-expected (O/E) ratios for composite morbidity/mortality, operative mortality, unplanned reoperation, stroke, renal failure, prolonged ventilation, and deep sternal wound infection and compared ratios among matched populations. Results: During the study period, 812 coronary artery bypass grafting patients received BIMA grafts, including 302 patients (37%) with diabetes. We matched 259 diabetic and nondiabetic BIMA patients. O/E ratios were higher in matched diabetic (versus nondiabetic) BIMA patients when comparing composite morbidity/mortality, reoperation, stroke, renal failure, and prolonged ventilation (all O/E ratios >1.0); however, the O/E ratio for operative mortality was higher in nondiabetic BIMA patients. We additionally matched 292 diabetic BIMA to diabetic LIMA patients. Diabetic BIMA patients had a higher O/E ratio for composite morbidity/mortality, operative mortality, stroke, renal failure, and prolonged ventilation. Conclusions: In this statewide analysis, diabetic patients who received BIMA grafts (compared with diabetic patients with LIMA grafts or nondiabetic patients with BIMA grafts) had higher O/E ratios for composite morbidity/mortality as a result of higher O/E ratios for major complications.
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U2 - 10.1016/j.athoracsur.2018.04.030
DO - 10.1016/j.athoracsur.2018.04.030
M3 - Article
C2 - 29758209
AN - SCOPUS:85051651912
SN - 0003-4975
VL - 106
SP - 1088
EP - 1094
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -