On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the bypass angioplasty revascularization investigation 2 diabetes trial

Ashima Singh, Hartzell V Schaff, Maria Mori Brooks, Mark A. Hlatky, Stephen R. Wisniewski, Robert L. Frye, Edward Y. Sako

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVES: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS: On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS: Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.

Original languageEnglish (US)
Article numberezv170
Pages (from-to)406-416
Number of pages11
JournalEuropean Journal of Cardio-thoracic Surgery
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Off-Pump Coronary Artery Bypass
Angioplasty
Coronary Artery Bypass
Type 2 Diabetes Mellitus
Transplants
Stroke
Myocardial Infarction
Propensity Score
Coronary Artery Disease
Mortality

Keywords

  • Coronary arteries bypass graft
  • Diabetic patients
  • Off-pump procedure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the bypass angioplasty revascularization investigation 2 diabetes trial. / Singh, Ashima; Schaff, Hartzell V; Mori Brooks, Maria; Hlatky, Mark A.; Wisniewski, Stephen R.; Frye, Robert L.; Sako, Edward Y.

In: European Journal of Cardio-thoracic Surgery, Vol. 49, No. 2, ezv170, 01.02.2016, p. 406-416.

Research output: Contribution to journalArticle

Singh, Ashima ; Schaff, Hartzell V ; Mori Brooks, Maria ; Hlatky, Mark A. ; Wisniewski, Stephen R. ; Frye, Robert L. ; Sako, Edward Y. / On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the bypass angioplasty revascularization investigation 2 diabetes trial. In: European Journal of Cardio-thoracic Surgery. 2016 ; Vol. 49, No. 2. pp. 406-416.
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abstract = "OBJECTIVES: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS: On-pump CABG was performed in 444 (72{\%}) patients, and off-pump CABG in 171 (28{\%}). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9{\%}, P = 0.02) despite fewer complications (10.3 vs 20.7{\%}, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS: Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.",
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AU - Mori Brooks, Maria

AU - Hlatky, Mark A.

AU - Wisniewski, Stephen R.

AU - Frye, Robert L.

AU - Sako, Edward Y.

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N2 - OBJECTIVES: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS: On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS: Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.

AB - OBJECTIVES: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS: On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS: Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG.

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KW - Diabetic patients

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