Faculty Collaboration Database

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. Eur J Cardiothorac Surg 2016 Feb;49(2):406-16

Date

05/15/2015

Pubmed ID

25968885

Pubmed Central ID

PMC4711702

DOI

10.1093/ejcts/ezv170

Scopus ID

2-s2.0-84959894500 (requires institutional sign-in at Scopus site)   22 Citations

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.

Author List

Singh A, Schaff HV, Mori Brooks M, Hlatky MA, Wisniewski SR, Frye RL, Sako EY, BARI 2D Study Group

Author

Ashima Singh PhD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease
Diabetes Mellitus, Type 2
Diabetic Angiopathies
Female
Humans
Male
Middle Aged
Myocardial Infarction
Myocardial Revascularization
Postoperative Complications
Propensity Score
Stroke