Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, USA.
Eur Heart J. 2022 Nov 21;43(44):4644-4652. doi: 10.1093/eurheartj/ehac199.
To evaluate the impact of multiple arterial grafting (MAG) vs. single arterial grafting (SAG) in a post hoc analysis of 10-year outcomes in patients with diabetes mellitus (DM) from the Arterial Revascularization Trial (ART).
The primary endpoint was all-cause mortality and the secondary endpoint was a composite of major adverse cardiac events (MACE) at 10-year follow-up. Patients were stratified by diabetes status (non-DM and DM) and grafting strategy (MAG vs. SAG). A total of 3020 patients were included in the analysis; 716 (23.7%) had DM. Overall, 55.8% non-DM patients received MAG and 44.2% received SAG, while 56.6% DM patients received MAG and 43.4% received SAG. The use of MAG compared with SAG was associated with lower 10-year mortality for both non-DM [17.7 vs. 21.0%, adjusted hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.72-1.06] and DM patients (21.5 vs. 29.9%, adjusted HR 0.65, 95% CI 0.48-0.89; P for interaction = 0.12). For both groups, the rate of 10-year MACE was also lower for MAG vs. SAG. Overall, deep sternal wound infections (DSWIs) were uncommon but more frequent in the MAG vs. SAG group in both non-DM (3.3 vs. 2.1%) and DM patients (7.9 vs. 4.8%). The highest rates of DSWI were in insulin-treated patients receiving MAG (9.6 vs. 6.3%, when compared with SAG).
In this post hoc analysis of the ART, MAG was associated with substantially lower mortality rates at 10 years after coronary artery bypass grafting in patients with DM. Patients with DM receiving MAG had a higher incidence of DSWI, especially if insulin dependent.
在冠状动脉旁路移植术后 10 年的结果的事后分析中，评估在糖尿病患者中，与单支动脉吻合（SAG）相比，多支动脉吻合（MAG）的影响。
主要终点是全因死亡率，次要终点是 10 年随访时主要不良心脏事件（MACE）的复合终点。根据糖尿病状态（非糖尿病和糖尿病）和吻合策略（MAG 与 SAG）对患者进行分层。共有 3020 例患者纳入分析，716 例（23.7%）患有糖尿病。总体而言，55.8%的非糖尿病患者接受 MAG，44.2%接受 SAG，而 56.6%的糖尿病患者接受 MAG，43.4%接受 SAG。与 SAG 相比，MAG 的使用与非糖尿病患者（17.7%比 21.0%，调整后的危险比[HR]0.87，95%置信区间[CI]0.72-1.06）和糖尿病患者（21.5%比 29.9%，调整后的 HR 0.65，95% CI 0.48-0.89；P 交互=0.12）的 10 年死亡率较低。对于两组患者，MAG 与 SAG 相比，10 年 MACE 发生率也较低。总的来说，深部胸骨伤口感染（DSWI）在 MAG 与 SAG 组中都不常见，但在非糖尿病（3.3%比 2.1%）和糖尿病患者（7.9%比 4.8%）中更常见。DSWI 的发生率最高的是接受 MAG 治疗的胰岛素治疗患者（9.6%比 6.3%，与 SAG 相比）。
在 ART 的事后分析中，与冠状动脉旁路移植术后 10 年的死亡率相比，MAG 与糖尿病患者的死亡率显著降低。接受 MAG 的糖尿病患者的 DSWI 发生率较高，尤其是胰岛素依赖型患者。
