Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehac199. https://doi.org/10.1093/eurheartj/ehac199 Dr. David Taggart et al
Points
- The use of multiple arterial grafts (MAG) during coronary artery bypass grafting (CABG) in diabetic patients was linked to a considerable decrease in the risk of 10-year mortality (HR, 0.65) when compared to the use of a single arterial graft (SAG), according to a recent post hoc analysis of the arterial revascularization trial, which included 3020 patients
- In individuals with and without diabetes, the incidence of 10-year serious adverse events was less with MAG than with SAG. Deep sternal wound infections, particularly in those with insulin-dependent diabetes, were more likely with MAG
- These results imply that MAG is linked to superior long-term outcomes in CABG patients with diabetes
Summary
Diabetic patients and multivessel coronary artery disease patients have shown that coronary artery bypass grafting (CABG) is preferable to percutaneous coronary intervention. It remained unclear, whether bilateral internal mammary artery (BIMA) transplantation would be preferable to left internal mammary artery (LIMA) grafting alone in patients who need numerous bypass grafts. In this study, patients with diabetes mellitus (DM) from the Arterial Revascularization Trial underwent post hoc analysis to compare the effects of multiple arterial grafting (MAG) and single arterial grafting (SAG) following 10-year results (ART).
All-cause death served as the primary goal, and a composite of major adverse cardiac events (MACE) at 10-year follow-up served as the secondary endpoint. Patients were grouped according to their grafting approach and diabetes status (non-DM and DM) (MAG vs. SAG). 716 (23.7 percent) of the 3020 patients who were included in the research had DM.
Overall, 56.6 percent of DM patients obtained MAG and 43.4 percent SAG, compared to 55.8 percent of non-DM patients and 44.2% of SAG recipients. Both non-DM and DM patients have lower 10-year mortality rates when using MAG in comparison to SAG. The frequency of 10-year MACE was likewise reduced for MAG vs. SAG for both groups. Both non-DM (3.3 vs. 2.1 percent) and DM patients experienced deep sternal wound infections (DSWIs), which were infrequent overall but more common in the MAG group compared to the SAG group (7.9 vs. 4.8 percent). Patients receiving MAG who were taking insulin had the highest prevalence of DSWI (9.6 vs. 6.3 percent, as compared to SAG). MAG was linked to noticeably decreased mortality rates at 10 years following coronary artery bypass grafting in patients with DM, according to this post hoc analysis of the ART. The incidence of DSWI was greater in patients with DM receiving MAG, particularly if they were insulin dependent.
Link to the article: https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehac199/6607811
References Taggart, D. P., Audisio, K., Gerry, S., Robinson, N. B., Rahouma, M., Soletti, G. Jr., Cancelli, G., Benedetto, U., Lees, B., Gray, A., Stefil, M., Flather, M., Gaudino, M., ART Investigators, Taggart, D., Ratnatunga, C., Westaby, S., Cook, J., Wallis, C., … Stacel, T. (2022). Single versus multiple arterial grafting in diabetic patients at 10 years: The Arterial Revascularization Trial. European Heart Journal, ehac199. https://doi.org/10.1093/eurheartj/ehac199
