Endo Masahiro, Tomizawa Yasuko, Nishida Hiroshi
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Circulation. 2003 Sep 16;108(11):1343-9. doi: 10.1161/01.CIR.0000085995.87982.6E. Epub 2003 Aug 25.
This historical cohort study evaluated the benefit of bilateral internal mammary artery (BIMA) grafts in coronary bypass grafting (CABG) for patients with diabetes.
We performed elective, isolated, primary, multiple CABG using skeletonized internal mammary artery (IMA) grafts for multivessel disease in 1131 patients, 467 (41.3%) of whom had type 2 diabetes mellitus. The early and long-term results were compared between 277 patients with diabetes using single IMA (SIMA) grafts and 190 using BIMA grafts (median follow-up, 8.1 years). Hospital mortality was similar in both groups. Early patency rate of all grafts was significantly higher using BIMA than using SIMA (97.7% versus 93.8%, P=0.0012). Survival rates were not significantly different between SIMA and BIMA groups. Late cardiac mortality was significantly higher in patients with low ejection fraction (0.4 or lower) compared with preserved ejection fraction (higher than 0.4) (P=0.0001). In patients with preserved ejection fraction, 10-year survival rate was significantly higher using BIMA than using SIMA (87.8+/-3.5% versus 75.2+/-3.4%, P=0.04), and 10-year all death-free or repeat CABG or recurrent myocardial infarction-free rate was significantly higher using BIMA than using SIMA (86.6+/-3.6% versus 69.0+/-3.7%, P=0.0086). The hazard ratio for all death or repeated CABG or recurrent myocardial infarction in patients with preserved ejection fraction was markedly lower in the BIMA group (0.53; 95% CI, 0.31 to 0.9; P=0.019).
Skeletonized BIMA grafts are beneficial in coronary revascularization for diabetic patients with preserved ejection fraction but have limited survival benefit for those with reduced ejection fraction attributable to high cardiac mortality.
这项历史性队列研究评估了双侧乳内动脉（BIMA）移植在糖尿病患者冠状动脉旁路移植术（CABG）中的益处。
我们对1131例多支血管病变患者进行了择期、孤立、初次、多次CABG，使用骨骼化乳内动脉（IMA）移植，其中467例（41.3%）患有2型糖尿病。比较了277例使用单支IMA（SIMA）移植的糖尿病患者和190例使用BIMA移植的糖尿病患者的早期和长期结果（中位随访时间为8.1年）。两组的医院死亡率相似。使用BIMA时所有移植血管的早期通畅率显著高于使用SIMA（97.7%对93.8%，P = 0.0012）。SIMA组和BIMA组的生存率无显著差异。与射血分数保留（高于0.4）的患者相比，射血分数低（0.4或更低）的患者晚期心脏死亡率显著更高（P = 0.0001）。在射血分数保留的患者中，使用BIMA的10年生存率显著高于使用SIMA（87.8±3.5%对75.2±3.4%，P = 0.04），使用BIMA的10年无全因死亡或再次CABG或无复发性心肌梗死率显著高于使用SIMA（86.6±3.6%对69.0±3.7%，P = 0.0086）。射血分数保留的患者中，BIMA组全因死亡或再次CABG或复发性心肌梗死的风险比显著更低（0.53；95%可信区间，0.31至0.9；P = 0.019）。
骨骼化BIMA移植对射血分数保留的糖尿病患者的冠状动脉血运重建有益，但对因心脏死亡率高而射血分数降低的患者生存益处有限。
