Optimal Conduit for Diabetic Patients: Propensity Analysis of Radial and Right Internal Thoracic Arteries

BACKGROUND:

Multiple arterial grafts, in addition to the left internal thoracic
artery, improve long-term survival after coronary artery bypass
grafting (CABG); yet, the use of this procedure remains low for both the
right internal thoracic
artery (RITA) and the radial artery (RA). To identify the optimal
arterial conduit to deploy for revascularization of diabetic patients,
we compared the outcomes for RA and RITA grafts to the circumflex
coronary.

METHODS:

From January 1, 1995, to December 31,
2011, 908 consecutive diabetic patients underwent first-time, isolated
CABG (99% on-pump), 659 with the RA and 502 with the RITA, respectively,
in two affiliated hospitals. Data were prospectively collected, and
late mortality was determined from the Social Security Death Index.
Propensity matching, based on preoperative and operative variables,
identified 202 matched pairs from each group.

RESULTS:

Long-term
survival was similar for matched patients. Mortality, myocardial
infarction, reoperation for bleeding, stroke, sepsis, and renal failure
were not significantly different between groups. However, deep sternal
wound infection (p < 0.035) and respiratory failure (p < 0.048) favored the RA group, in which the total major adverse events were significantly fewer (p = 0.002).

CONCLUSIONS:

In diabetic
patients undergoing multivessel revascularization with either RA or
RITA grafts to the circumflex coronary, long-term survival is similar.
However, RA patients experienced significantly fewer respiratory or
sternal wound adverse events. The RA is the preferred conduit to extend
to more diabetic patients the recognized survival benefit of a multiple
arterial graft strategy.