Late outcomes of off-pump versus on-pump coronary bypass in patients with diabetes: A nationwide study from Taiwan

Late outcomes of off-pump versus on-pump coronary bypass in patients with diabetes: A nationwide study from Taiwan

Although the benefits and risks of on- and off-pump coronary artery bypass have been compared in several clinical trials, large-scale studies regarding long-term outcomes in patients with diabetes are lacking. We compared long-term outcomes after on- and off-pump coronary artery bypass in patients w...

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Veröffentlicht in:The Journal of thoracic and cardiovascular surgery 2019-03, Vol.157 (3), p.960-969.e2
Hauptverfasser: Huang, Kuan-Chih, Wu, I-Hui, Chou, Nai-Kuan, Yang, Yen-Yun, Lin, Lung-Chun, Yu, Hsi-Yu, Chi, Nai-Hsin
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coronary artery bypass grafting
diabetes mellitus
off-pump
on-pump
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container_issue 3
container_start_page 960
container_title The Journal of thoracic and cardiovascular surgery
container_volume 157
creator Huang, Kuan-Chih
Wu, I-Hui
Chou, Nai-Kuan
Yang, Yen-Yun
Lin, Lung-Chun
Yu, Hsi-Yu
Chi, Nai-Hsin
description Although the benefits and risks of on- and off-pump coronary artery bypass have been compared in several clinical trials, large-scale studies regarding long-term outcomes in patients with diabetes are lacking. We compared long-term outcomes after on- and off-pump coronary artery bypass in patients with diabetes. We evaluated outcomes in 16,215 patients with diabetes who underwent isolated coronary artery bypass from 2000 to 2011. Clinical data validity was regulated by the single-payer, universal, and nationwide reimbursement systems. Long-term outcomes were compared using propensity score matched analyses. Off-pump surgery was associated with a greater incidence of repeat revascularization (P = .0036) in the long term. Propensity score matching identified 3796 patients in each group. There were no significant differences between on- and off-pump surgery regarding the long-term risks of mortality (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.87-1.02, P = .1667), stroke (HR, 0.97; 95% CI, 0.87-1.09, P = .6074), and myocardial infarction (HR, 1.05; 95% CI, 0.91-1.20, P = .5207). Off-pump surgery offered a survival benefit within 30 days (HR on vs off, 1.52, 95% CI, 1.24-1.85, P 
doi_str_mv 10.1016/j.jtcvs.2018.08.084
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We compared long-term outcomes after on- and off-pump coronary artery bypass in patients with diabetes. We evaluated outcomes in 16,215 patients with diabetes who underwent isolated coronary artery bypass from 2000 to 2011. Clinical data validity was regulated by the single-payer, universal, and nationwide reimbursement systems. Long-term outcomes were compared using propensity score matched analyses. Off-pump surgery was associated with a greater incidence of repeat revascularization (P = .0036) in the long term. Propensity score matching identified 3796 patients in each group. There were no significant differences between on- and off-pump surgery regarding the long-term risks of mortality (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.87-1.02, P = .1667), stroke (HR, 0.97; 95% CI, 0.87-1.09, P = .6074), and myocardial infarction (HR, 1.05; 95% CI, 0.91-1.20, P = .5207). Off-pump surgery offered a survival benefit within 30 days (HR on vs off, 1.52, 95% CI, 1.24-1.85, P &lt; .0001). In patients with diabetes and end-stage renal disease, on-pump surgery provided a significant long-term survival benefit (HR on vs off, 0.68, 95% CI, 0.51-0.91). In patients with diabetes undergoing isolated coronary artery bypass, off-pump surgery provided a 30-day benefit in mortality, but both groups had similar long-term survival. In off-pump surgery, repeat revascularization was a concern in the long term. 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subjects coronary artery bypass grafting
diabetes mellitus
off-pump
on-pump
title Late outcomes of off-pump versus on-pump coronary bypass in patients with diabetes: A nationwide study from Taiwan
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