Xu Fei, Li Lei, Zhou Chenghui, Wang Sheng, Ao Hushan
Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Department of Cardiovascular Surgery, Affiliated Hospital of Weifang Medical University, 261071 Weifang, Shandong, China.
Rev Cardiovasc Med. 2024 Sep 24;25(9):349. doi: 10.31083/j.rcm2509349. eCollection 2024 Sep.
For diabetic patients undergoing coronary artery bypass grafting (CABG), there is still a debate about whether an off-pump or on-pump approach is advantageous.
A retrospective review of 1269 consecutive diabetic patients undergoing isolated, primary CABG surgery from January 1, 2013 to December 31, 2015 was conducted. Among them, 614 received non-cardiopulmonary bypass treatment during their operation (off-pump group), and 655 received cardiopulmonary bypass treatment (on-pump group). The hospitalization outcomes were compared by multiple logistic regression models with patient characteristics and operative variables as independent variables. Kaplan-Meier curves and Cox proportional-hazard regression models for mid-term (2-year) and long-term (5-year) clinical survival analyses were used to determine the effect on survival after CABG surgery. In order to further verify the reliability of the results, propensity-score matching (PSM) was also performed between the two groups.
Five-year all-cause death rates were 4.23% off-pump vs. 5.95% on-pump ( = 0.044), and off-pump was associated with reduced postoperative stroke and atrial fibrillation.
These findings suggest that off-pump procedures may have benefits for diabetic patients in CABG.
对于接受冠状动脉旁路移植术（CABG）的糖尿病患者，非体外循环或体外循环方法哪种更具优势仍存在争议。
对2013年1月1日至2015年12月31日期间连续接受孤立性、原发性CABG手术的1269例糖尿病患者进行回顾性研究。其中，614例患者在手术期间接受非体外循环治疗（非体外循环组），655例接受体外循环治疗（体外循环组）。以患者特征和手术变量作为自变量，通过多元逻辑回归模型比较住院结局。采用Kaplan-Meier曲线和Cox比例风险回归模型进行中期（2年）和长期（5年）临床生存分析，以确定对CABG手术后生存的影响。为进一步验证结果的可靠性，两组之间还进行了倾向评分匹配（PSM）。
非体外循环组的5年全因死亡率为4.23%，体外循环组为5.95%（P = 0.044），非体外循环与术后中风和房颤减少相关。
这些发现表明，非体外循环手术可能对接受CABG的糖尿病患者有益。
