Diabetes and Long-Term Bypass Graft Patency

Study Questions:

How does diabetes influence long-term coronary artery bypass graft patency?

Methods:

Data were evaluated from a single center from 1979 to 2011. A total of 57,961 patients underwent coronary artery bypass grafting (CABG), of which 11,519 underwent post-operative angiography. Graft patency was compared between pharmacologically treated diabetics (n = 1,372; 3,796 grafts) and nondiabetics (n = 10,147; 24,664 grafts).

Results:

Internal thoracic artery (ITA) patency (>90%) was stable over time in both diabetics and nondiabetics over the study period (p = NS). Saphenous vein graft (SVG) patency declined steadily over the study period in both diabetic and nondiabetic patients. At 10 years, <60% of SVGs were patent in either diabetic (57%) or nondiabetic (58%) patients. After adjusting for patient characteristics, ITA grafts had higher early patency in diabetics compared with nondiabetics; however, this was no longer significant on late follow-up. Early or late SVG patency rates did not differ in patients with or without diabetics.

Conclusions:

ITA grafts provide excellent long-term patency rates in all patients regardless of diabetes. Similarly, SVG patency, although low on long-term follow-up, is not influenced by diabetes.

Perspective:

This single-center retrospective analysis of a large cohort of patients undergoing CABG puts into question the adverse metabolic influence of diabetes on long-term CABG patency rates. Even though diabetic patients undergoing CABG have higher mortality compared with nondiabetics, this does not seem to be driven by differences in graft patency, and other clinical factors may play a more prominent role. ITA graft patency is excellent in all patients, and their use should be mandated in all patients undergoing CABG.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angiography, Cardiac Surgical Procedures, Coronary Artery Bypass, Diabetes Mellitus, Graft Occlusion, Vascular, Mammary Arteries, Postoperative Period, Saphenous Vein, Secondary Prevention, Thoracic Arteries


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