Total arterial revascularization: a superior strategy for diabetic patients who require coronary surgery

Tatoulis, James, Wynne, Rochelle, Skillington, Peter D. and Buxton, Brian F. 2016, Total arterial revascularization: a superior strategy for diabetic patients who require coronary surgery, Annals of thoracils surgery, vol. 102, no. 6, pp. 1948-1955, doi: 10.1016/j.athoracsur.2016.05.062.

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Title Total arterial revascularization: a superior strategy for diabetic patients who require coronary surgery
Author(s) Tatoulis, James
Wynne, Rochelle
Skillington, Peter D.
Buxton, Brian F.
Journal name Annals of thoracils surgery
Volume number 102
Issue number 6
Start page 1948
End page 1955
Total pages 8
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2016-12
ISSN 0003-4975
Keyword(s) Australia
Blood Loss, Surgical
Coronary Artery Bypass
Coronary Disease
Databases, Factual
Diabetes Complications
Follow-Up Studies
Graft Occlusion, Vascular
Kaplan-Meier Estimate
Myocardial Revascularization
Postoperative Complications
Postoperative Hemorrhage
Propensity Score
Radial Artery
Risk Factors
Summary BACKGROUND: Recent large randomized trials and metaanalyses have shown that, for patients with diabetes mellitus and advanced coronary artery disease, coronary artery bypass graft surgery (CABG) was superior to percutaneous intervention. We investigated whether total arterial revascularization (TAR) conferred an additional survival advantage for diabetic patients having CABG. METHODS: We reviewed 63,592 cases from an audited, collaborative Australian cardiac surgical database. A total of 34,181 patients undergoing first time isolated CABG from 2001 to 2012 were identified. Of the 34,181, 11,642 (34.1%) were diabetic patients, and TAR was performed in 12,271 of 34,181 (35.9%). Of the 11,642 diabetic patients, TAR was performed in 3,795 (32.6%) and non-TAR in 7,847 (67.4%). Propensity matching resulted in 6,232 matched pairs of patients who did and patients who did not have TAR. Data were linked to the National Death Index. RESULTS: In the propensity matched sample, of 6,232 diabetic patients, 2,017 (32.4%) underwent TAR and 1,967 (31.6%) did not (p = 0.337). Mean follow-up was 4.9 years. Perioperative mortality, including 30-day mortality, was similar: 1.2% (24 of 2,017) for TAR and 1.4% (28 of 1,967) for non-TAR (p = 0.506). Late mortality was less among diabetic patients who underwent TAR, 10.2% (205 of 2,017), than no TAR, 12.2% (240 of 1,967; p = 0.041). Kaplan-Meier survival for the diabetic TAR group at 1, 5, and 10 years was 96.2%, 88.9%, and 82.2%, respectively, versus 95.4%, 87.5%, and 78.3% for the diabetic non-TAR group (log rank, p = 0.036). CONCLUSIONS: In a large propensity matched cohort of patients having CABG, TAR demonstrated further long-term prognostic benefit for diabetic patients, in the context of equivalent perioperative mortality.
Language eng
DOI 10.1016/j.athoracsur.2016.05.062
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
110201 Cardiology (incl Cardiovascular Diseases)
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Society of Thoracic Surgeons
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Document type: Journal Article
Collection: School of Nursing and Midwifery
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