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Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Cardiovascular Surgery, Mount Sinai Morningside, New York, NYDepartment of Cardiovascular Surgery, Mount Sinai Downtown, New York, NYDepartment of Cardiovascular Surgery, Mount Sinai West, New York, NY
Address for reprints: Natalia Egorova, PhD, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029.
Data on long-term outcomes in patients with diabetes receiving multiarterial grafting (MAG) versus single-artery grafting (SAG) are limited.
Objectives
The objective of this study is to compare long-term outcomes between MAG and SAG for coronary artery bypass graft (CABG) surgery in patients with diabetes.
Methods
Patients with diabetes who underwent isolated CABG surgeries between 2000 to 2016 were identified using the New Jersey mandatory state clinical registry linked with death records and hospital discharge data (last follow-up December 31, 2019). Patients who underwent CABG for single-vessel disease, with only venous conduits, patients with previous heart surgeries, or hemodynamically unstable were excluded. Patients undergoing MAG and SAG were matched by propensity score. Cox proportional hazard models were used to investigate long-term survival and competing risk analysis was used for secondary outcomes.
Results
Of 24,944 patients, 2955 underwent MAG, and 21,989 underwent SAG CABG. Patients receiving MAG were younger, predominantly men, with a lower prevalence of hypertension, peripheral vascular disease, congestive heart failure, chronic lung disease, and renal failure. MAG was associated with lower long-term mortality compared with SAG in 2882 propensity score-matched pairs (hazard ratio [HR], 0.75; 95% CI, 0.68-0.83); lower risks of repeat revascularization (subdistribution HR, 0.86; 95% CI, 0.76-0.97); and composite outcome defined as death from any cause, stroke, postoperative myocardial infarction, and/or repeat revascularization (HR, 0.76; 95% CI, 0.71-0.82). These results were confirmed in subgroup analyses of women, men, age <70 years, and age ≥70 years patients with diabetes. MAG was also associated with lower mortality compared with SAG in patients with diabetes taking insulin in the entire cohort (Video Abstract).
Conclusions
Patients with diabetes benefit from receiving MAG over SAG and demonstrated improved long-term survival, and lower hazards of secondary and composite outcomes. Coordinated efforts are needed to offer MAG to patients with diabetes.
In comparison to single-arterial, multiarterial grafting could offer improved long-term survival and lower hazards of repeat revascularizations in patients with diabetes undergoing CABG surgery.
Patients with diabetes constitute a large proportion of patients who undergo CABG surgery. These patients tend to have more comorbid conditions compared with patients without diabetes, which could influence prognosis after surgery. Our observations of the benefits of MAG over SAG on long-term outcomes could assist surgeons in their decision to offer this grafting procedure to patients with diabetes.
Almost 40% of patients undergoing coronary artery bypass graft (CABG) surgery have diabetes.
Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm.
Due to this large proportion and the nature of the disease affecting coronary vessels, studying different revascularization procedures in this patient population with the aim to improve long-term outcomes is necessary.
Recent publications have advised that patients with diabetes should be considered for assessment by a multidisciplinary heart team to choose the optimal procedure for CABG surgery but there is no specific recommendation for the choice of multiarterial graft (MAG) versus single-artery graft (SAG) in this group. Patients with diabetes have more comorbidities than patients without diabetes such as hypertension, hyperlipidemia, and obesity—all of which contribute to an increased risk of cardiovascular events and affect prognosis after surgery.
2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines [published correction appears in Circulation. 2022;145(11):e771].
It has been demonstrated that arterial grafts are superior to venous grafts in terms of angiographic patency and survival rates but data on long-term outcomes in patients with diabetes receiving MAG versus SAG are very limited in both clinical trials and observational studies.
A recent report from the Society of Thoracic Surgeons database showed a decline in the utilization of multiarterial CABG for all patients from 2008 to 2018 despite the reported benefits and recommendations by guidelines.
The current evidence about MAG versus SAG outcomes for patients with diabetes is inconsistent. Results from a recent retrospective study using SYNTAX trial extended survival data comparing the use of MAG and SAG over 12.6 years in a subgroup of patients (n = 362) with diabetes showed that MAG was associated with a decreased risk of unadjusted hazards of death (hazard ratio [HR], 0.67; 95% CI, 0.46-0.97) but the propensity score-matched adjusted hazards of deaths showed no difference (HR, 0.73; 95% CI, 0.43-1.24).
Results from another study that tested the hypothesis of improved long-term survival when using the radial artery as a second conduit in patients with diabetes who underwent isolated CABG at a single medical center showed a 30% reduction in mortality in a 409 propensity score-matched pairs (HR, 0.683; 95% CI, 0.507-0.920; P < .01).
Improving long term outcome for diabetic patients undergoing surgical revascularization by use of the radial artery conduit: a propensity matched study.
The objective of this study was to compare long-term outcomes between MAG and SAG for CABG surgery in patients with diabetes.
Methods
Study Design and Data Sources
This is a retrospective cohort analysis. The mandatory New Jersey State Open Heart Registry was used to identify patients undergoing MAG CABG between January 1, 2000, and December 31, 2016, and obtain their baseline characteristics such as age, sex, medical history, preoperative risk factors, and operative information. New Jersey hospitals are required by law to report data to the State Department of Health on each patient undergoing open heart surgery. The Open-Heart Surgery Registry contains this patient-level data from 1994 to present. To obtain information on the primary outcome and long-term survival, we linked this database to New Jersey vital statistics death registry. Secondary outcomes were obtained through linkage with New Jersey hospital discharge data and Cardiac Catheterization Registry (Table E1). The last follow-up date was December 31, 2019.
The New Jersey Open-Heart Surgery Registry provides data from all hospitals that are licensed to perform adult open-heart surgery. Contributing hospitals submit their data to the New Jersey Department of Health every quarter and are given time to update the submitted data. Upon submission of the final updated data from the hospitals, the Department of Health reviews the submissions and draws a sample. An assigned auditor reviews the sampled medical records for consistency and accuracy. The New Jersey Catheterization Registry is a mandatory database that documents both inpatient and outpatient diagnostic and therapeutic catheterization procedures. The New Jersey Discharge Data Collection System is a mandated administrative database that collects data prospectively on inpatient, emergency, and ambulatory visits.
This study was approved by institutional review boards at Mount Sinai (STUDY-15-00,807-CR003; August 10, 2022) and the New Jersey Department of Health. The approval included a waiver of informed consent.
Study Population
New Jersey resident patients were included if they were diagnosed with diabetes and multiple coronary vessel disease and underwent isolated multi-vessel CABG containing at least 1 arterial conduit. Multivessel disease, SAG, and MAG were identified through the Open-Heart Surgery Registry using the following variables: number of diseased vessels, number of anastomoses using arterial conduits, and number of anastomoses using venous conduits.
The cohort comprised male and female patients from different age groups with or without multiple comorbidities who underwent isolated CABG. Patients who underwent CABG for single vessel disease, underwent CABG with only venous conduits, patients with previous heart surgeries, and hemodynamically unstable (ie, preoperative shock, cardiopulmonary resuscitation, or inotrope requirement), and patients who are non-New Jersey residents were excluded (Figure E1).
Study End Points
The primary outcome was long-term survival. The secondary outcomes were: first instance of myocardial infarction (MI), stroke, repeat revascularization, 30-day deep sternal wound infection (DSWI), and a composite outcome comprising: death from any cause, stroke, MI, and/or repeat revascularization. Time to the composite outcome was defined on the first instance of any of the events described. Subjects were determined to have had an MI through either the index admission or postdischarge. MI, occurring during the index admission was identified using Open Heart Surgery Registry. MI occurring postdischarge was defined as the primary diagnosis of MI and was identified using the New Jersey Discharge Data Collection System. A stroke was defined as permanent neurologic deficit due to an ischemic or hemorrhagic cerebrovascular event not including transient ischemic attacks. It was identified using the Open Heart Surgery Registry, the Cardiac Catheterization Registry, and the New Jersey Discharge Data Collection System. Repeat revascularization was defined as a postoperative redo-CABG or percutaneous coronary intervention and was identified using both Open Heart Surgery Registry and the Cardiac Catheterization Registry, as well as the New Jersey Discharge Data Collection System. DSWI occurring during the index admission was identified using Open Heart Surgery Registry or by primary International Classification of Diseases ninth edition (before October 1, 2015) or 10th edition (starting October 1, 2015) diagnosis codes for readmissions within 30-day postsurgery using the New Jersey Discharge Data Collection System.
Statistical Analysis
All statistical analyses were performed with SAS software (SAS Institute Inc). Baseline characteristics, including demographic characteristics and preoperative variables were analyzed and compared between MAG and SAG groups. The χ2 or Fisher exact test was used when appropriate for analysis of categorical variables and the t test for normally distributed or Wilcoxon test for nonnormally distributed continuous variables. Normality was examined using Kolmogorov-Smirnov test. Continuous variables were reported as means ± SD or median with interquartile range depending on distribution, and categorical variables were reported as proportions. A total of 5.8% patients with missing unique identifiers were excluded from the study. Two variables (renal failure and dyslipidemia) had missing data below 1%. All models were developed on complete records only.
The propensity score matching was used to create a cohort of MAG and SAG patients with a similar distribution of baseline characteristics. We used logistic regression to calculate propensity score. The 1:1 matching was performed using an optimal matching method with a caliper width of 0.10 of the logit of the propensity score. We perform exact matching on the number of the diseased vessels and propensity matching for other covariates that included age, gender, race, body mass index, the presence of peripheral vascular disease, hypertension, smoking, dyslipidemia, chronic lung disease, previous MI, prior percutaneous coronary intervention, renal failure without and with dialysis, cerebrovascular disease, and preoperative conditions (ejection fraction and the presence of left main disease) and preoperative status, year of surgery, and surgeon's CABG case volume (CABG surgeries performed in the 365 days before each subject's surgery date).
Baseline characteristics for propensity score-matched pairs were compared using standardized mean differences (SMD), and P values were calculated using paired Student t test for continuous, and McNemar's test categorical, variables. The matching was considered optimal if SMD <10%.
To estimate patients' survival, we graphed a Kaplan-Meier curve. Comparisons were performed using the log-rank test for unmatched patients. We used a marginal Cox model with a sandwich robust estimator for the comparison of survival for patients with MAG versus SAG for propensity score-matched groups. Survival estimates at 15 years after surgery were derived from the time-to-event analysis life tables. Competing risk analysis was performed for secondary outcomes using subdistribution hazard and the long-term outcomes were compared using Fine-Gray P values. Patients are censored at the end of follow-up (December 31, 2019).
Subgroup analyses of women, men, patients younger than age 70 years, aged 70 years or older, and insulin and noninsulin dependent patients with diabetes were also performed. New propensity score matches utilizing the same methods described above were used to create matched pairs for each of the subgroups. Two-sided significance testing was used throughout the analysis.
Results
We identified 24,944 patients with diabetes who underwent CABG surgery for multivessel disease between January 1, 2000, and December 31, 2016. Of these, 2955 (11.85%) patients underwent MAG and 21,989 (88.15%) underwent SAG procedure. The median follow-up time was 6.8 years. In patients with diabetes undergoing CABG surgery, the rates of MAG procedures utilized by surgeons decreased from 20% to 8% between 2000 and 2016 (Figure 1).
Figure 1Trend in utilization of multiarterial graft for patients with diabetes with multivessel coronary artery disease.
Table 1 shows baseline characteristics of the patients included in the study. Patients with diabetes receiving MAG were younger (aged 62 years vs 67 years; P < .001), predominantly men, with a lower prevalence of hypertension, peripheral vascular disease, congestive heart failure, chronic lung disease, renal failure, and dyslipidemia. Additionally, the number of grafts received was higher in MAG than in SAG groups.
Table 1Baseline characteristics of patients with diabetes undergoing single- versus multiple-arterial revascularization
Propensity score matching produced 2882 pairs with SMD <10% for all covariates, suggesting a good balance of covariates between SAG and MAG patients (Table 1 and Figure E2). In the propensity score-matched cohorts, the mean age was 62 years for MAG patients and 63 years for SAG patients. There was a similar prevalence of hypertension, peripheral vascular disease, congestive heart failure, and chronic lung disease in both groups. Excluded patients (5.8%) due to missing unique identifiers had similar distributions of important baseline characteristics to those in our cohort in both groups (MAG and SAG) (Table E2).
The incidence of DSWI within 30 days after surgery in the entire cohort was 5.11% in MAG and 4.26% in SAG. There was a difference in an unadjusted analysis (McNemar's test P = .03). However, there was no difference after PSM (P = .36).
In our cohort of patients who underwent MAG, 53.8% received the right internal thoracic artery as the second conduit and 46.2% received the radial artery as the second conduit. The incidence of DSWI within 30 days after surgery was 5.24% in patients who received the right internal thoracic artery as the second conduit and 5.03% in patients who received the radial artery as the second conduit (P = .81).
Unadjusted Results
MAG was associated with a lower 15-year mortality compared to SAG in the overall cohort (HR, 0.65; 95% CI, 0.61-0.70). Survival at 15 years for MAG vs SAG was (60% vs 47%; P < .001). There was no difference between MAG and SAG in the cumulative incidence of long-term MI (subdistribution HR [SHR], 0.97, 95% CI, 0.85-1.10) or long-term stroke (SHR, 0.91; 95% CI, 0.76-1.03). MAG was associated with a higher risk of repeat revascularization compared with SAG (SHR, 1.12; 95% CI, 1.02-1.23). The risk of composite outcome was lower in MAG versus SAG (HR, 0.76; 95% CI, 0.72-0.81).
Adjusted Results
In 2882 propensity score-matched pairs, MAG was associated with lower mortality compared with SAG (HR, 0.75; 95% CI, 0.68-0.83) (Figure 2). Survival at 15 years for MAG versus SAG was (61% vs 51%; P < .001). MAG was also associated with a lower risk of repeat revascularization (SHR, 0.86; 95% CI, 0.76-0.97) and composite outcome (HR, 0.76; 95% CI, 0.71-0.82). There was no difference between MAG and SAG in the cumulative incidence of long-term MI or stroke (Figure 3).
Figure 2Long-term survival after multiarterial versus single-arterial coronary artery bypass grafting for patients with diabetes. MAG, Multiarterial graft; SAG, single-artery graft; HR, hazard ratio; CI, confidence interval.
These results were confirmed in subgroup analyses of women, men, and patients younger than age 70 years and aged 70 years or older with diabetes. MAG was associated with lower 15-year mortality in 600 propensity score-matched pairs of a subgroup of women (HR, 0.83; 95% CI, 0.68-0.99), in 2282 propensity score-matched pairs of men (HR, 0.69, 95% CI, 0.62-0.78), in 625 propensity score-matched pairs of patients aged 70 years and older (HR, 0.83; 95% CI, 0.70-0.97) and in 2255 propensity-matched pairs of patients aged younger than 70 years (HR, 0.73, 95% CI, 0.65-0.83) (Figure 4).
Figure 4Risk of mortality and composite outcome (mortality, myocardial infarction, stroke, or repeat revascularization) for patients with diabetes who underwent single arterial graft (reference group) versus multiarterial graft for multivessel coronary artery disease in the propensity score-matched patients and in the subgroup of patients with diabetes (female, male patients, patients younger than age 70 years and patients aged 70 years or older). MAG, Multiarterial graft; SAG, single-artery graft.
Additionally, a subgroup analysis comparing long-term survival for patients with diabetes taking insulin in our cohort (n = 5755), showed that MAG was associated with lower mortality compared with SAG (unadjusted HR, 0.73; 95% CI, 0.62-0.87) and a trend toward lower mortality compared with SAG in a 515 propensity score-matched pairs in a propensity score-matched analysis (HR, 0.83; 95% CI, 0.66-1.05).
Sensitivity Analysis
We performed an additional analysis matching patients who underwent off-pump to on-pump surgery. The SMD for off-pump versus on-pump surgeries after matching was 2%, which indicates a good balance. The distribution of off-pump surgery in the 2 groups before matching was the following: 56.65% of patients underwent MAG and 30.71% SAG procedures. The distribution of off-pump surgery after matching was 57.26% for MAG and 60.13% for SAG procedures.
The outcomes in the propensity score-matched analysis were similar to the outcomes of the original analysis in our matched cohort. MAG was associated with lower long-term mortality compared with SAG in the propensity score-matched pairs (HR, 0.77; 95% CI, 0.70-0.84), lower risks of repeat revascularization (SHR, 0.86; 95% CI, 0.76-0.98) and composite outcome (HR, 0.78; 95% CI, 0.72-0.84). There was no difference in the cumulative incidence of long-term MI or stroke.
Additionally, we controlled for incomplete revascularization in the propensity score matching model. Incomplete revascularization was defined as more diseased vessels than the number of grafts received. Propensity score matching was performed; the SMD for incomplete revascularization after matching was 3%, suggesting good balance. Before matching, the distribution of incomplete revascularization in the 2 groups was as follow: 6.53% among MAG and 12.39% among patients who underwent SAG procedures. The distribution of incomplete revascularization after matching was 6.6% among MAG and 7.7% among SAG patients. The outcomes in the propensity score-matched pairs were similar to the outcomes of the original analysis in our matched cohort. MAG was associated with a lower long-term mortality compared with SAG in the propensity score-matched pairs (HR, 0.78; 95% CI, 0.71-0.86) and lower risks of composite outcome (HR, 0.81; 95% CI, 0.75-0.88). There was no difference between MAG and SAG in the cumulative incidence of long-term MI, repeat revascularization, or stroke.
Discussion
Patients with diabetes have an increased risk and acceleration of atherosclerosis leading to a more diffuse narrowing of coronary arteries hence the need for an optimal treatment is essential. This study showed an advantage of performing a MAG over SAG CABG on long-term outcomes in patients with diabetes. The use of MAG was associated with a 25% lower risk of mortality compared with SAG in our propensity score-matched cohort (Figure 5).
In this study, we identified baselines differences between patients receiving MAG and those receiving SAG; patients receiving MAG were younger, predominately men, and with fewer comorbid conditions. Similar differences in baseline characteristics were also described for patients receiving MAG and SAG in patients with or without diabetes.
Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes mellitus.
We performed propensity score matching to balance the characteristics of patients who underwent MAG and SAG procedures to diminish the selection bias.
The results of our study supplement the results of a subgroup analysis in a recently published observational study that used SYNTAX trial extended survival data and reported a significant decrease of the hazards of death (33%) in MAG compared with SAG in an unadjusted survival analysis. However, after they adjusted for differences in baseline characteristics, the hazards of death showed a nonsignificant trend toward lower mortality in MAG versus SAG.
Survival at 15 years for MAG versus SAG in our study was 61% versus 51%, which is comparable to the longest reported survival in the previous study, which reported 60% versus 43% survival at 12.6 years for MAG versus SAG.
Another study from Cleveland Clinic showed that the use of bilateral internal thoracic artery was associated with a 21% lower late mortality than single internal thoracic artery in 11,922 patients with diabetes who underwent primary isolated CABG from January 1972 to January 2011. The median follow-up was 7.8 years.
single-center study that reported a 12-year survival of 64.9% versus 58.8% (P = .04) for MAG versus SAG in a small, propensity score-matched patient cohort.
Our study enhances these results by offering a much larger cohort of patients with diabetes. We have also used propensity score matching to balance the baseline characteristics in patients receiving MAG and SAG. Our study offers more information on cause-specific long-term outcomes (MI, stroke, repeat revascularization, and composite outcome) due to the advantage of linking the Open-Heart Surgery Registry with discharge database, death records, and a cardiac catheterization registry.
Several retrospective studies identified diabetes as among the risk factors of DSWI after CABG. Other risk factors included female sex and obesity.
Our study showed a higher risk of developing DSWI within 30 days after surgery in MAG versus SAG patients in the unadjusted cohort (P = .03) but there was no difference after propensity score matching. Recently published results of a post hoc analysis of the Arterial Revascularization Trial for patients with diabetes showed that MAG had a higher incidence of DSWI compared with SAG (7.9% vs 4.8%), (adjusted HR, 1.80; 95% CI, 0.92-3.52).
This difference could be due to differences in patients' characteristics or intraoperative factors such as the choice of arterial conduit, which could aid surgeons to further explore subgroups of patients who could be more prone to developing sternal wound infections postoperatively and study different grafting techniques. Further clinical trials exploring these outcomes in patients with diabetes are needed. In our study, patients' characteristics were balanced between both groups to decrease selection bias and increase internal validity of our results.
We performed a subgroup analysis of patients with diabetes aged 70 years or older, younger than age 70 years, male and female, and those taking insulin that showed significant long-term survival benefits of MAG over SAG in all of these subgroups. Results from recent published studies comparing the use of MAG versus SAG on long-term mortality in women undergoing isolated CABG showed inconsistent results. There was no difference in long-term mortality between MAG and SAG in 1860 matched pairs of women (HR, 0.99; 95% CI, 0.84-1.15).
We could not find comparative results for MAG versus SAG among women with diabetes. We demonstrated that the use of MAG among women with diabetes was associated with decreased risk of long-term mortality.
Our results could assist surgeons in choosing MAG for patients with diabetes with the aim of optimizing long-term outcomes and survival. Both, US and European guidelines, in their latest publications, advised that patients with diabetes should be considered for assessment by a multidisciplinary heart team to choose the optimal procedure for CABG surgery and advised that future research is needed in this high-risk patient population to find strategies and procedures that could decrease the rate of long-term adverse events and increase survival.
2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines [published correction appears in Circulation. 2022;145(11):e771].
Whereas MAG CABG is encouraged to be used for multivessel disease, sentences such as “more research is needed” or “not enough clinical trial data available” could have contributed to the low rate of the use of MAG. Practice guidelines do not distinguish between clinical subgroups of patients undergoing CABG surgery for multivessel disease. Additional factors contributing to the pattern seen in the use of MAG are the lack of evidence regarding survival and long-term outcomes from large randomized clinical trials, the surgical technical challenges, and longer operative times associated with the use of MAG.
To our knowledge, this is the first study that used a large cohort to evaluate long-term mortality and other important long-terms outcomes of MAG versus SAG in patients with diabetes and among subgroups of people with diabetes, as well. Time and expense limit clinical trials; they need a longer timeline after randomization to evaluate long-term outcomes. A larger sample size will be needed for subgroup analysis in clinical trials but large datasets do not have these limitations.
Strength and Limitations
Given the limited data on the effect of MAG versus SAG on long-term outcomes in patients with diabetes, we believe the results concluded in our study will generate more knowledge on this matter and thus aid surgeons in choosing a grafting strategy that could possibly decrease long-term mortality and cause-specific outcomes. Using mandatory, large clinical registries and administrative databases produced a large sample size that includes patients with preoperative characteristics that were not included in clinical trials; thus, this sample of patients is anticipated to be more representative of the general population.
Similar to any retrospective cohort study, our study is predisposed to the limitations of observational studies, confounding variables, and selection bias. We used propensity score matching to control for selection bias in our study. Also, this study is limited to 1 state only, which could affect the generalizability of the results. Another limitation is that some patients moved out of the state after surgery and were lost to follow-up. We understand that some patients seeking treatment in other states could result in an underestimation of the intervention rates, but this should not influence our study because we only included patients who underwent surgery in New Jersey and were residents of the state during the study. We understand that patient adherence to secondary preventative measures post-CABG is an important factor that could have a profound influence on long-term outcomes, but this was not captured in these databases.
Conclusions
In this retrospective cohort analysis of data from mandatory New Jersey state registry linked with death records and hospital discharge databases, patients with diabetes benefit from receiving MAG over SAG. MAG was associated with improved long-term survival, lower hazards of repeat revascularization and the composite outcome of death from any cause, stroke, postdischarge MI, and/or repeat revascularization. Coordinated efforts are needed to offer MAG to patients with diabetes.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
OHSR within 30-d postoperatively: CSTERNAL Diagnosis codes (occurred during the index admission, or diagnosis for readmissions within 30-d postsurgery) ICD-9: 99,859, 99,832, 99,831, 5192 ICD-10: T8140XA, T8131XA, T8132XA, J985
ICD, International Classification of Diseases; CABG, coronary artery bypass grafting; Y, yes; N, no; PCI, percutaneous coronary intervention; NYHA, New York Heart Association.
Table E2Comparison of important baseline characteristics between patients with diabetes who were excluded due to missing unique identifiers and patients with diabetes who were included in the analysis
Overall excluded (n = 1840)
Overall included (n = 24,944)
P value
MAG excluded (n = 214)
MAG included (n = 2955)
P value
SAG excluded (n = 1626)
SAG included (n = 21,989)
P value
Demographic
Age (y)
66.51 ± 10.01
66.14 ± 10.05
.08
62.92 ± 9.59
61.88 ± 10.26
.11
66.98 ± 9.98
66.71 ± 9.88
.20
Gender
.68
.95
.69
Female
28.91
28.42
21.50
21.05
29.89
29.41
Male
71.07
71.58
78.50
78.95
70.11
70.59
Preoperative conditions
Left main disease
32.75
32.85
.88
28.30
30.14
.45
33.33
33.22
.91
No. of grafts
.96
.59
.89
2
16.90
16.70
14.02
12.66
17.28
17.34
3
83.10
83.21
85.98
87.34
82.72
82.66
Preoperative status
.41
.60
.55
Elective
34.08
32.83
40.19
37.60
33.27
32.19
Urgent
63.53
64.71
58.41
60.64
64.21
65.26
Emergency
2.39
2.45
1.40
1.67
2.52
2.55
Values are presented as mean ± SD or %. MAG, Multiarterial graft; SAG, single-artery graft.
Figure E2Standardized mean differences before and after matching. PCI, Percutaneous coronary intervention; BMI, body mass index; CABG, coronary artery bypass grafting; Obs, observations.
Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm.
2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines [published correction appears in Circulation. 2022;145(11):e771].
Improving long term outcome for diabetic patients undergoing surgical revascularization by use of the radial artery conduit: a propensity matched study.
Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes mellitus.
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