Bilateral Internal Mammary Artery Use in Diabetic Patients

Friend or Foe?

Investigators for the Maryland Cardiac Surgery Quality Initiative

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)1088-1094
Number of pages7
JournalAnnals of Thoracic Surgery
Volume106
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Mammary Arteries
Mortality
Morbidity
Coronary Artery Bypass
Renal Insufficiency
Transplants
Ventilation
Stroke
Reoperation
Wound Infection

All Science Journal Classification (ASJC) codes

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

Cite this

Investigators for the Maryland Cardiac Surgery Quality Initiative. / Bilateral Internal Mammary Artery Use in Diabetic Patients : Friend or Foe?. In: Annals of Thoracic Surgery. 2018 ; Vol. 106, No. 4. pp. 1088-1094.
@article{aac580f67c974d799386956c95cb35af,
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.",
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 John Conte and Rawn Salenger and Whitman, {Glenn J.}",
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Investigators for the Maryland Cardiac Surgery Quality Initiative 2018, 'Bilateral Internal Mammary Artery Use in Diabetic Patients: Friend or Foe?', Annals of Thoracic Surgery, vol. 106, no. 4, pp. 1088-1094. https://doi.org/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.

In: Annals of Thoracic Surgery, Vol. 106, No. 4, 01.10.2018, p. 1088-1094.

Research output: Contribution to journalArticle

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

AU - Salenger, Rawn

AU - Whitman, Glenn J.

PY - 2018/10/1

Y1 - 2018/10/1

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.

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Investigators for the Maryland Cardiac Surgery Quality Initiative. Bilateral Internal Mammary Artery Use in Diabetic Patients: Friend or Foe? Annals of Thoracic Surgery. 2018 Oct 1;106(4):1088-1094. https://doi.org/10.1016/j.athoracsur.2018.04.030