Coronary bypass graft patency in patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

Leonard Schwartz, Kevin E. Kip, Robert L. Frye, Edwin L. Alderman, Hartzell V Schaff, Katherine M. Detre

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background - Few studies have compared long-term status of bypass grafts between patients with and without diabetes, and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG. Methods and Results - Among 1526 patients in BARI who underwent CABG as initial revascularization, 99 of 292 (34%) with treated diabetes mellitus (TDM) (those on insulin or oral hypoglycemic agents) and 469 of 1234 (38%) without TDM had follow-up angiography. Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention (mean 3.9 years) were reviewed. An average of 3.0 grafts were placed at initial CABG for patients with TDM (n=297; internal mammary artery [IMA], 33%) and 2.9 grafts for patients without TDM (n=1347; IMA, 34%). Patients with TDM were more likely than those without to have small (<1.5 mm) grafted distal vessels (29% versus 22%) and vessels of poor quality (9% versus 6%). On follow-up angiography, 89% of IMA grafts were free of stenoses ≥50% among patients with TDM versus 85% among patients without TDM (P=0.23). For vein grafts, the corresponding percentages were 71% versus 75% (P=0.40). After statistical adjustment, TDM was unrelated to having a graft stenosis ≥50% (adjusted odds ratio, 0.87; 95% CI, 0.58 to 1.32). Conclusions - Despite diabetic patients' having smaller distal vessels and vessels judged to be of poorer quality, diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up. Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes.

Original languageEnglish (US)
Pages (from-to)2652-2658
Number of pages7
JournalCirculation
Volume106
Issue number21
DOIs
StatePublished - Nov 19 2002

Fingerprint

Angioplasty
Diabetes Mellitus
Transplants
Mammary Arteries
Angiography
Veins
Pathologic Constriction
Hypoglycemic Agents
Uncertainty
Odds Ratio
Insulin
Survival
Mortality

Keywords

  • Angiography
  • Bypass
  • Diabetes mellitus
  • Follow-up studies
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary bypass graft patency in patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI). / Schwartz, Leonard; Kip, Kevin E.; Frye, Robert L.; Alderman, Edwin L.; Schaff, Hartzell V; Detre, Katherine M.

In: Circulation, Vol. 106, No. 21, 19.11.2002, p. 2652-2658.

Research output: Contribution to journalArticle

Schwartz, Leonard ; Kip, Kevin E. ; Frye, Robert L. ; Alderman, Edwin L. ; Schaff, Hartzell V ; Detre, Katherine M. / Coronary bypass graft patency in patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI). In: Circulation. 2002 ; Vol. 106, No. 21. pp. 2652-2658.
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abstract = "Background - Few studies have compared long-term status of bypass grafts between patients with and without diabetes, and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG. Methods and Results - Among 1526 patients in BARI who underwent CABG as initial revascularization, 99 of 292 (34{\%}) with treated diabetes mellitus (TDM) (those on insulin or oral hypoglycemic agents) and 469 of 1234 (38{\%}) without TDM had follow-up angiography. Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention (mean 3.9 years) were reviewed. An average of 3.0 grafts were placed at initial CABG for patients with TDM (n=297; internal mammary artery [IMA], 33{\%}) and 2.9 grafts for patients without TDM (n=1347; IMA, 34{\%}). Patients with TDM were more likely than those without to have small (<1.5 mm) grafted distal vessels (29{\%} versus 22{\%}) and vessels of poor quality (9{\%} versus 6{\%}). On follow-up angiography, 89{\%} of IMA grafts were free of stenoses ≥50{\%} among patients with TDM versus 85{\%} among patients without TDM (P=0.23). For vein grafts, the corresponding percentages were 71{\%} versus 75{\%} (P=0.40). After statistical adjustment, TDM was unrelated to having a graft stenosis ≥50{\%} (adjusted odds ratio, 0.87; 95{\%} CI, 0.58 to 1.32). Conclusions - Despite diabetic patients' having smaller distal vessels and vessels judged to be of poorer quality, diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up. Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes.",
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T1 - Coronary bypass graft patency in patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI)

AU - Schwartz, Leonard

AU - Kip, Kevin E.

AU - Frye, Robert L.

AU - Alderman, Edwin L.

AU - Schaff, Hartzell V

AU - Detre, Katherine M.

PY - 2002/11/19

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N2 - Background - Few studies have compared long-term status of bypass grafts between patients with and without diabetes, and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG. Methods and Results - Among 1526 patients in BARI who underwent CABG as initial revascularization, 99 of 292 (34%) with treated diabetes mellitus (TDM) (those on insulin or oral hypoglycemic agents) and 469 of 1234 (38%) without TDM had follow-up angiography. Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention (mean 3.9 years) were reviewed. An average of 3.0 grafts were placed at initial CABG for patients with TDM (n=297; internal mammary artery [IMA], 33%) and 2.9 grafts for patients without TDM (n=1347; IMA, 34%). Patients with TDM were more likely than those without to have small (<1.5 mm) grafted distal vessels (29% versus 22%) and vessels of poor quality (9% versus 6%). On follow-up angiography, 89% of IMA grafts were free of stenoses ≥50% among patients with TDM versus 85% among patients without TDM (P=0.23). For vein grafts, the corresponding percentages were 71% versus 75% (P=0.40). After statistical adjustment, TDM was unrelated to having a graft stenosis ≥50% (adjusted odds ratio, 0.87; 95% CI, 0.58 to 1.32). Conclusions - Despite diabetic patients' having smaller distal vessels and vessels judged to be of poorer quality, diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up. Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes.

AB - Background - Few studies have compared long-term status of bypass grafts between patients with and without diabetes, and uncertainty exists as to whether diabetes independently predicts poor clinical outcome after CABG. Methods and Results - Among 1526 patients in BARI who underwent CABG as initial revascularization, 99 of 292 (34%) with treated diabetes mellitus (TDM) (those on insulin or oral hypoglycemic agents) and 469 of 1234 (38%) without TDM had follow-up angiography. Angiograms with the longest interval from initial surgery and before any percutaneous graft intervention (mean 3.9 years) were reviewed. An average of 3.0 grafts were placed at initial CABG for patients with TDM (n=297; internal mammary artery [IMA], 33%) and 2.9 grafts for patients without TDM (n=1347; IMA, 34%). Patients with TDM were more likely than those without to have small (<1.5 mm) grafted distal vessels (29% versus 22%) and vessels of poor quality (9% versus 6%). On follow-up angiography, 89% of IMA grafts were free of stenoses ≥50% among patients with TDM versus 85% among patients without TDM (P=0.23). For vein grafts, the corresponding percentages were 71% versus 75% (P=0.40). After statistical adjustment, TDM was unrelated to having a graft stenosis ≥50% (adjusted odds ratio, 0.87; 95% CI, 0.58 to 1.32). Conclusions - Despite diabetic patients' having smaller distal vessels and vessels judged to be of poorer quality, diabetes does not appear to adversely affect patency of IMA or vein grafts over an average of 4-year follow-up. Previously observed differences in survival between CABG-treated patients with and without diabetes may be largely a result of differential risk of mortality from noncardiac causes.

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