Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?

Ioannis K. Toumpoulis, Constantine E. Anagnostopoulos, Sandhya Balaram, Daniel G. Swistel, Robert C. Ashton, Joseph DeRose

Research output: Contribution to journalArticle

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Abstract

Background. The purpose of the present study was to determine whether long-term survival in diabetic patients increased after bilateral internal thoracic artery (BITA) coronary bypass compared with matched patients with single internal thoracic artery (SITA) coronary bypass. Methods. The propensity for BITA was determined using logistic regression analysis and each BITA patient was matched with one SITA patient. Between January 1992 and March 2002, 980 matched diabetic patients (490 BITA versus 490 SITA) underwent coronary artery bypass surgery. Long-term survival data were obtained from the National Death Index (mean follow-up, 4.7 ± 3.0 years). Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. Results. Multivariate Cox regression analysis determined that BITA grafting had no significant effect on long-term survival (hazard ratio 0.89, 95% confidence interval: 0.69 to 1.14, p = 0.343). There were no differences in 30-day mortality (3.9% for BITA versus 3.7%, p = 0.999) and major postoperative complications except for length of stay (11.4 days for BITA versus 12.7 days, p < 0.001). Five-year survival rate was 79.9% in the BITA group and 75.7% in the SITA group (p = 0.252). There was no difference in 5-year survival rate between matched patients younger than 60 or from 70 to 79 years old. However, BITA patients aged 60 to 69 years had better 5-year survival rates (84.1% versus 71.0%, p = 0.0196), whereas the opposite was observed in patients aged more than 79 years (5-year survival for BITA 43.1% versus 70.0%, p = 0.016). Conclusions. Bilateral internal thoracic artery grafting had no significant effect on long-term survival for diabetic patients, but it may increase long-term survival in patients aged 60 to 69 years, whereas SITA grafting may be beneficial for patients more than 79 years old.

Original languageEnglish (US)
Pages (from-to)599-607
Number of pages9
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 2006
Externally publishedYes

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Mammary Arteries
Survival
Survival Rate
Regression Analysis
Proportional Hazards Models
Coronary Artery Bypass

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients? / Toumpoulis, Ioannis K.; Anagnostopoulos, Constantine E.; Balaram, Sandhya; Swistel, Daniel G.; Ashton, Robert C.; DeRose, Joseph.

In: Annals of Thoracic Surgery, Vol. 81, No. 2, 02.2006, p. 599-607.

Research output: Contribution to journalArticle

Toumpoulis, Ioannis K. ; Anagnostopoulos, Constantine E. ; Balaram, Sandhya ; Swistel, Daniel G. ; Ashton, Robert C. ; DeRose, Joseph. / Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 2. pp. 599-607.
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abstract = "Background. The purpose of the present study was to determine whether long-term survival in diabetic patients increased after bilateral internal thoracic artery (BITA) coronary bypass compared with matched patients with single internal thoracic artery (SITA) coronary bypass. Methods. The propensity for BITA was determined using logistic regression analysis and each BITA patient was matched with one SITA patient. Between January 1992 and March 2002, 980 matched diabetic patients (490 BITA versus 490 SITA) underwent coronary artery bypass surgery. Long-term survival data were obtained from the National Death Index (mean follow-up, 4.7 ± 3.0 years). Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. Results. Multivariate Cox regression analysis determined that BITA grafting had no significant effect on long-term survival (hazard ratio 0.89, 95{\%} confidence interval: 0.69 to 1.14, p = 0.343). There were no differences in 30-day mortality (3.9{\%} for BITA versus 3.7{\%}, p = 0.999) and major postoperative complications except for length of stay (11.4 days for BITA versus 12.7 days, p < 0.001). Five-year survival rate was 79.9{\%} in the BITA group and 75.7{\%} in the SITA group (p = 0.252). There was no difference in 5-year survival rate between matched patients younger than 60 or from 70 to 79 years old. However, BITA patients aged 60 to 69 years had better 5-year survival rates (84.1{\%} versus 71.0{\%}, p = 0.0196), whereas the opposite was observed in patients aged more than 79 years (5-year survival for BITA 43.1{\%} versus 70.0{\%}, p = 0.016). Conclusions. Bilateral internal thoracic artery grafting had no significant effect on long-term survival for diabetic patients, but it may increase long-term survival in patients aged 60 to 69 years, whereas SITA grafting may be beneficial for patients more than 79 years old.",
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T1 - Does bilateral internal thoracic artery grafting increase long-term survival of diabetic patients?

AU - Toumpoulis, Ioannis K.

AU - Anagnostopoulos, Constantine E.

AU - Balaram, Sandhya

AU - Swistel, Daniel G.

AU - Ashton, Robert C.

AU - DeRose, Joseph

PY - 2006/2

Y1 - 2006/2

N2 - Background. The purpose of the present study was to determine whether long-term survival in diabetic patients increased after bilateral internal thoracic artery (BITA) coronary bypass compared with matched patients with single internal thoracic artery (SITA) coronary bypass. Methods. The propensity for BITA was determined using logistic regression analysis and each BITA patient was matched with one SITA patient. Between January 1992 and March 2002, 980 matched diabetic patients (490 BITA versus 490 SITA) underwent coronary artery bypass surgery. Long-term survival data were obtained from the National Death Index (mean follow-up, 4.7 ± 3.0 years). Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. Results. Multivariate Cox regression analysis determined that BITA grafting had no significant effect on long-term survival (hazard ratio 0.89, 95% confidence interval: 0.69 to 1.14, p = 0.343). There were no differences in 30-day mortality (3.9% for BITA versus 3.7%, p = 0.999) and major postoperative complications except for length of stay (11.4 days for BITA versus 12.7 days, p < 0.001). Five-year survival rate was 79.9% in the BITA group and 75.7% in the SITA group (p = 0.252). There was no difference in 5-year survival rate between matched patients younger than 60 or from 70 to 79 years old. However, BITA patients aged 60 to 69 years had better 5-year survival rates (84.1% versus 71.0%, p = 0.0196), whereas the opposite was observed in patients aged more than 79 years (5-year survival for BITA 43.1% versus 70.0%, p = 0.016). Conclusions. Bilateral internal thoracic artery grafting had no significant effect on long-term survival for diabetic patients, but it may increase long-term survival in patients aged 60 to 69 years, whereas SITA grafting may be beneficial for patients more than 79 years old.

AB - Background. The purpose of the present study was to determine whether long-term survival in diabetic patients increased after bilateral internal thoracic artery (BITA) coronary bypass compared with matched patients with single internal thoracic artery (SITA) coronary bypass. Methods. The propensity for BITA was determined using logistic regression analysis and each BITA patient was matched with one SITA patient. Between January 1992 and March 2002, 980 matched diabetic patients (490 BITA versus 490 SITA) underwent coronary artery bypass surgery. Long-term survival data were obtained from the National Death Index (mean follow-up, 4.7 ± 3.0 years). Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. Results. Multivariate Cox regression analysis determined that BITA grafting had no significant effect on long-term survival (hazard ratio 0.89, 95% confidence interval: 0.69 to 1.14, p = 0.343). There were no differences in 30-day mortality (3.9% for BITA versus 3.7%, p = 0.999) and major postoperative complications except for length of stay (11.4 days for BITA versus 12.7 days, p < 0.001). Five-year survival rate was 79.9% in the BITA group and 75.7% in the SITA group (p = 0.252). There was no difference in 5-year survival rate between matched patients younger than 60 or from 70 to 79 years old. However, BITA patients aged 60 to 69 years had better 5-year survival rates (84.1% versus 71.0%, p = 0.0196), whereas the opposite was observed in patients aged more than 79 years (5-year survival for BITA 43.1% versus 70.0%, p = 0.016). Conclusions. Bilateral internal thoracic artery grafting had no significant effect on long-term survival for diabetic patients, but it may increase long-term survival in patients aged 60 to 69 years, whereas SITA grafting may be beneficial for patients more than 79 years old.

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