Long-Term Outcome of Total Arterial Myocardial Revascularization Versus Conventional Coronary Artery Bypass in Diabetic and Non -Diabetic Patients: A Propensity-Match Analysis

Objective: Despite the improved survival in patientswith multi-vessel coronary disease compared to conventional myocardial revascularization associated with the use ofmultiple arterial grafting for myocardial revascularization, it has been adopted in theminority of centers. We sought to evaluate the long-termoutcome of patientswith and without diabetes undergoing total arterial versus conventional myocardial revascularization. Methods: Among 1000 consecutive patients undergoing CABG, we performed a propensity-match analysis to compare patients with multi-vessel disease receiving total arterial (G1=618 pts) versus conventional myocardial revascularization ( LIMA-LAD plus vein grafts, G2=382 pts). The primary end-point was survival free from all-cause and cardiac-related mortality, while the secondary end-point was the occurrence of major cardiac and cerebrovascular accidents. Results: Hospital mortality was similar (G1: 0 pts. vs G2: 1 pts., 0.3%, p=.91). At a median follow-up of 101 months (range 11-185 months), total arterial grafting was associated with significantly improved survival free from overall (G1=76.5 +/- 3.0% vs G2 = 66.0 +/- 3.1%; p<.001) and cardiac mortality (general population: G1 = 90.8 +/- 2.1% vs G2 = 84.2 +/- 1.9%, p=.043; diabetics:G1 = 84.7 +/- 2.1 vs G2: 79.3 +/- 3.4; p=.035) as well as occurrence of MACCEs (general population:G1 = 80.1 +/- 3.2% vs G2 = 70.8 +/- 2.9%; p<.001; diabetics: G1 = 77 +/- 6 vs G2 = 53 +/- 5.8; p<.001). Cox regression analysis identified diabetes (HR = 1.94, CI 95% = 1.12-2.93; p<.001) and the use of veins (HR = 1.81, CI 95% = 1.32-2.65; p<.001) as independent predictors for all-cause mortality; among diabetics, vein grafts was the strongest predictor of MACCEs (HR = 2.41, CI 95% = 1.27-4.59; p=.007) and cardiac mortality (HR = 3.24, CI 95% = 1.69-6.23; p<.001). Conclusions: Long-term survival following total arterial CABG is remarkably improved compared to conventional grafting with vein grafts especially in diabetic patients. (C) 2019 Elsevier Inc. All rights reserved.