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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
- Source :
- European Journal of Cardio-Thoracic Surgery. 49:406-416
- Publication Year :
- 2015
- Publisher :
- Oxford University Press (OUP), 2015.
-
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.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease
Type 2 diabetes
030204 cardiovascular system & hematology
Revascularization
Coronary artery disease
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Internal medicine
Angioplasty
Myocardial Revascularization
Diabetes Mellitus
medicine
Humans
Myocardial infarction
Coronary Artery Bypass
Propensity Score
Stroke
Off-pump coronary artery bypass
Adult Cardiac
business.industry
Hazard ratio
General Medicine
Middle Aged
medicine.disease
Treatment Outcome
Diabetes Mellitus, Type 2
030228 respiratory system
Cardiology
Female
Surgery
Cardiology and Cardiovascular Medicine
business
Diabetic Angiopathies
Subjects
Details
- ISSN :
- 1873734X and 10107940
- Volume :
- 49
- Database :
- OpenAIRE
- Journal :
- European Journal of Cardio-Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....2cae88a9411c55da2cbb1fc8ab1932ce