Alsaleh Doaa, Sun Erick, Alzahrani Anas, Itagaki Shinobu, Puskas John, Chikwe Joanna, Egorova Natalia
Population Health Science and Policy New York, NY.
King Abdullah International Medical Research Center, NGHA, Riyadh, Saudi Arabia.
JTCVS Open. 2023 Jan 28;13:119-135. doi: 10.1016/j.xjon.2023.01.010. eCollection 2023 Mar.
Data on long-term outcomes in patients with diabetes receiving multiarterial grafting (MAG) versus single-artery grafting (SAG) are limited.
The objective of this study is to compare long-term outcomes between MAG and SAG for coronary artery bypass graft (CABG) surgery in patients with diabetes.
Patients with diabetes who underwent isolated CABG surgeries between 2000 to 2016 were identified using the New Jersey mandatory state clinical registry linked with death records and hospital discharge data (last follow-up December 31, 2019). Patients who underwent CABG for single-vessel disease, with only venous conduits, patients with previous heart surgeries, or hemodynamically unstable were excluded. Patients undergoing MAG and SAG were matched by propensity score. Cox proportional hazard models were used to investigate long-term survival and competing risk analysis was used for secondary outcomes.
Of 24,944 patients, 2955 underwent MAG, and 21,989 underwent SAG CABG. Patients receiving MAG were younger, predominantly men, with a lower prevalence of hypertension, peripheral vascular disease, congestive heart failure, chronic lung disease, and renal failure. MAG was associated with lower long-term mortality compared with SAG in 2882 propensity score-matched pairs (hazard ratio [HR], 0.75; 95% CI, 0.68-0.83); lower risks of repeat revascularization (subdistribution HR, 0.86; 95% CI, 0.76-0.97); and composite outcome defined as death from any cause, stroke, postoperative myocardial infarction, and/or repeat revascularization (HR, 0.76; 95% CI, 0.71-0.82). These results were confirmed in subgroup analyses of women, men, age <70 years, and age ≥70 years patients with diabetes. MAG was also associated with lower mortality compared with SAG in patients with diabetes taking insulin in the entire cohort (Video Abstract).
Patients with diabetes benefit from receiving MAG over SAG and demonstrated improved long-term survival, and lower hazards of secondary and composite outcomes. Coordinated efforts are needed to offer MAG to patients with diabetes.
关于接受多动脉移植（MAG）与单动脉移植（SAG）的糖尿病患者长期预后的数据有限。
本研究的目的是比较糖尿病患者冠状动脉旁路移植术（CABG）中MAG和SAG的长期预后。
利用与死亡记录和医院出院数据相链接的新泽西州强制性州临床登记系统（最后随访时间为2019年12月31日），确定2000年至2016年间接受单纯CABG手术的糖尿病患者。排除接受单支血管疾病CABG、仅使用静脉导管、既往有心脏手术史或血流动力学不稳定的患者。接受MAG和SAG的患者按倾向评分进行匹配。采用Cox比例风险模型研究长期生存情况，采用竞争风险分析评估次要结局。
在24944例患者中，2955例接受了MAG，21989例接受了SAG CABG。接受MAG的患者更年轻，以男性为主，高血压、外周血管疾病、充血性心力衰竭、慢性肺病和肾衰竭的患病率较低。在2882对倾向评分匹配的患者中，与SAG相比，MAG与较低的长期死亡率相关（风险比[HR]，0.75；95%CI，0.68 - 0.83）；再次血运重建风险较低（亚分布HR，0.86；95%CI，0.76 - 0.97）；以及定义为任何原因导致的死亡、中风、术后心肌梗死和/或再次血运重建的复合结局风险较低（HR，0.76；95%CI，0.71 - 0.82）。这些结果在糖尿病女性、男性、年龄<70岁和年龄≥70岁患者的亚组分析中得到证实。在整个队列中，接受胰岛素治疗的糖尿病患者中，与SAG相比，MAG也与较低的死亡率相关（视频摘要）。
糖尿病患者接受MAG比接受SAG更有益，长期生存率提高，次要结局和复合结局风险降低。需要做出协调努力，为糖尿病患者提供MAG。
