Bilateral Internal Mammary Artery Use in Diabetic Patients: Friend or Foe?

Investigators for the Maryland Cardiac Surgery Quality Initiative

doi:10.1016/j.athoracsur.2018.04.030

Bilateral Internal Mammary Artery Use in Diabetic Patients: Friend or Foe?

Investigators for the Maryland Cardiac Surgery Quality Initiative

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only.

METHODS: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables. Diabetic BIMA patients were matched 1:1 by nearest neighbor matching to nondiabetic BIMA patients and were separately matched 1:1 to diabetic LIMA patients. We calculated observed-to-expected (O/E) ratios for composite morbidity/mortality, operative mortality, unplanned reoperation, stroke, renal failure, prolonged ventilation, and deep sternal wound infection and compared ratios among matched populations.

RESULTS: During the study period, 812 coronary artery bypass grafting patients received BIMA grafts, including 302 patients (37%) with diabetes. We matched 259 diabetic and nondiabetic BIMA patients. O/E ratios were higher in matched diabetic (versus nondiabetic) BIMA patients when comparing composite morbidity/mortality, reoperation, stroke, renal failure, and prolonged ventilation (all O/E ratios >1.0); however, the O/E ratio for operative mortality was higher in nondiabetic BIMA patients. We additionally matched 292 diabetic BIMA to diabetic LIMA patients. Diabetic BIMA patients had a higher O/E ratio for composite morbidity/mortality, operative mortality, stroke, renal failure, and prolonged ventilation.

CONCLUSIONS: In this statewide analysis, diabetic patients who received BIMA grafts (compared with diabetic patients with LIMA grafts or nondiabetic patients with BIMA grafts) had higher O/E ratios for composite morbidity/mortality as a result of higher O/E ratios for major complications.

Original language	English
Pages (from-to)	1088-1094
Number of pages	7
Journal	The Annals of thoracic surgery
Volume	106
Issue number	4
DOIs	https://doi.org/10.1016/j.athoracsur.2018.04.030
State	Published - Oct 2018
Externally published	Yes

Keywords

Coronary Artery Bypass/methods
Coronary Artery Disease/complications
Diabetes Mellitus
Female
Follow-Up Studies
Hospital Mortality/trends
Humans
Male
Mammary Arteries/transplantation
Maryland/epidemiology
Middle Aged
Morbidity/trends
Postoperative Complications/epidemiology
Propensity Score
Retrospective Studies
Survival Rate/trends

Access to Document

10.1016/j.athoracsur.2018.04.030

Cite this

@article{091811597f4040cca0578324e6be74a2,

title = "Bilateral Internal Mammary Artery Use in Diabetic Patients: Friend or Foe?",

abstract = "BACKGROUND: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only.METHODS: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables. Diabetic BIMA patients were matched 1:1 by nearest neighbor matching to nondiabetic BIMA patients and were separately matched 1:1 to diabetic LIMA patients. We calculated observed-to-expected (O/E) ratios for composite morbidity/mortality, operative mortality, unplanned reoperation, stroke, renal failure, prolonged ventilation, and deep sternal wound infection and compared ratios among matched populations.RESULTS: During the study period, 812 coronary artery bypass grafting patients received BIMA grafts, including 302 patients (37%) with diabetes. We matched 259 diabetic and nondiabetic BIMA patients. O/E ratios were higher in matched diabetic (versus nondiabetic) BIMA patients when comparing composite morbidity/mortality, reoperation, stroke, renal failure, and prolonged ventilation (all O/E ratios >1.0); however, the O/E ratio for operative mortality was higher in nondiabetic BIMA patients. We additionally matched 292 diabetic BIMA to diabetic LIMA patients. Diabetic BIMA patients had a higher O/E ratio for composite morbidity/mortality, operative mortality, stroke, renal failure, and prolonged ventilation.CONCLUSIONS: In this statewide analysis, diabetic patients who received BIMA grafts (compared with diabetic patients with LIMA grafts or nondiabetic patients with BIMA grafts) had higher O/E ratios for composite morbidity/mortality as a result of higher O/E ratios for major complications.",

keywords = "Coronary Artery Bypass/methods, Coronary Artery Disease/complications, Diabetes Mellitus, Female, Follow-Up Studies, Hospital Mortality/trends, Humans, Male, Mammary Arteries/transplantation, Maryland/epidemiology, Middle Aged, Morbidity/trends, Postoperative Complications/epidemiology, Propensity Score, Retrospective Studies, Survival Rate/trends",

author = "{Investigators for the Maryland Cardiac Surgery Quality Initiative} and Crawford, {Todd C} and Xun Zhou and Fraser, {Charles D} and Magruder, {J Trent} and Alejandro Suarez-Pierre and Diane Alejo and Jennifer Bobbitt and Fonner, {Clifford E} and Kurt Wehberg and Brad Taylor and Christopher Kwon and Michael Fiocco and Conte, {John V} and Rawn Salenger and Whitman, {Glenn J}",

year = "2018",

month = oct,

doi = "10.1016/j.athoracsur.2018.04.030",

language = "English",

volume = "106",

pages = "1088--1094",

journal = "The Annals of thoracic surgery",

issn = "0003-4975",

number = "4",

}

TY - JOUR

T1 - Bilateral Internal Mammary Artery Use in Diabetic Patients

T2 - Friend or Foe?

AU - Investigators for the Maryland Cardiac Surgery Quality Initiative

AU - Crawford, Todd C

AU - Zhou, Xun

AU - Fraser, Charles D

AU - Magruder, J Trent

AU - Suarez-Pierre, Alejandro

AU - Alejo, Diane

AU - Bobbitt, Jennifer

AU - Fonner, Clifford E

AU - Wehberg, Kurt

AU - Taylor, Brad

AU - Kwon, Christopher

AU - Fiocco, Michael

AU - Conte, John V

AU - Salenger, Rawn

AU - Whitman, Glenn J

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only.METHODS: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables. Diabetic BIMA patients were matched 1:1 by nearest neighbor matching to nondiabetic BIMA patients and were separately matched 1:1 to diabetic LIMA patients. We calculated observed-to-expected (O/E) ratios for composite morbidity/mortality, operative mortality, unplanned reoperation, stroke, renal failure, prolonged ventilation, and deep sternal wound infection and compared ratios among matched populations.RESULTS: During the study period, 812 coronary artery bypass grafting patients received BIMA grafts, including 302 patients (37%) with diabetes. We matched 259 diabetic and nondiabetic BIMA patients. O/E ratios were higher in matched diabetic (versus nondiabetic) BIMA patients when comparing composite morbidity/mortality, reoperation, stroke, renal failure, and prolonged ventilation (all O/E ratios >1.0); however, the O/E ratio for operative mortality was higher in nondiabetic BIMA patients. We additionally matched 292 diabetic BIMA to diabetic LIMA patients. Diabetic BIMA patients had a higher O/E ratio for composite morbidity/mortality, operative mortality, stroke, renal failure, and prolonged ventilation.CONCLUSIONS: In this statewide analysis, diabetic patients who received BIMA grafts (compared with diabetic patients with LIMA grafts or nondiabetic patients with BIMA grafts) had higher O/E ratios for composite morbidity/mortality as a result of higher O/E ratios for major complications.

AB - BACKGROUND: Bilateral internal mammary artery (BIMA) grafting in diabetic patients undergoing coronary artery bypass grafting remains controversial. Our study compared morbidity and mortality between (1) diabetic and nondiabetic BIMA patients and (2) diabetic BIMA versus diabetic patients who underwent left internal mammary artery (LIMA) grafting only.METHODS: Patients who underwent isolated coronary artery bypass grafting from July 2011 to June 2016 at any of the 10 Maryland Cardiac Surgery Quality Initiative centers were propensity scored across 16 variables. Diabetic BIMA patients were matched 1:1 by nearest neighbor matching to nondiabetic BIMA patients and were separately matched 1:1 to diabetic LIMA patients. We calculated observed-to-expected (O/E) ratios for composite morbidity/mortality, operative mortality, unplanned reoperation, stroke, renal failure, prolonged ventilation, and deep sternal wound infection and compared ratios among matched populations.RESULTS: During the study period, 812 coronary artery bypass grafting patients received BIMA grafts, including 302 patients (37%) with diabetes. We matched 259 diabetic and nondiabetic BIMA patients. O/E ratios were higher in matched diabetic (versus nondiabetic) BIMA patients when comparing composite morbidity/mortality, reoperation, stroke, renal failure, and prolonged ventilation (all O/E ratios >1.0); however, the O/E ratio for operative mortality was higher in nondiabetic BIMA patients. We additionally matched 292 diabetic BIMA to diabetic LIMA patients. Diabetic BIMA patients had a higher O/E ratio for composite morbidity/mortality, operative mortality, stroke, renal failure, and prolonged ventilation.CONCLUSIONS: In this statewide analysis, diabetic patients who received BIMA grafts (compared with diabetic patients with LIMA grafts or nondiabetic patients with BIMA grafts) had higher O/E ratios for composite morbidity/mortality as a result of higher O/E ratios for major complications.

KW - Coronary Artery Bypass/methods

KW - Coronary Artery Disease/complications

KW - Diabetes Mellitus

KW - Female

KW - Follow-Up Studies

KW - Hospital Mortality/trends

KW - Humans

KW - Male

KW - Mammary Arteries/transplantation

KW - Maryland/epidemiology

KW - Middle Aged

KW - Morbidity/trends

KW - Postoperative Complications/epidemiology

KW - Propensity Score

KW - Retrospective Studies

KW - Survival Rate/trends

U2 - 10.1016/j.athoracsur.2018.04.030

DO - 10.1016/j.athoracsur.2018.04.030

M3 - Article

C2 - 29758209

SN - 0003-4975

VL - 106

SP - 1088

EP - 1094

JO - The Annals of thoracic surgery

JF - The Annals of thoracic surgery

IS - 4

ER -