Abstract
Background The optimal choice of conduit and configuration for coronary artery bypass grafting
(CABG) in diabetic patients remains somewhat controversial, even though arterial grafts
have been proposed as superior. We attempted to clarify the role of complete arterial
revascularization using the left internal thoracic artery (LITA) and the radial artery
(RA) alone in “T-Graft” configuration on long-term outcome.
Methods and Results From 1994 to 2001, 104 diabetic patients with triple vessel disease underwent CABG
using LITA/RA “T-Grafts” (Group-A). Using propensity-score matching, 104 patients
with comparable preoperative characteristics who underwent CABG using LITA and one
sequential vein graft were identified (Group-V). Freedom from all causes of death,
cardiac death, major adverse cardiac event (MACE), major adverse cardiac (and cerebral)
event (MACCE), and repeat revascularization at 10 years of Group-A was 60 ± 5%, 67 ± 5%,
48 ± 5%, 37 ± 5%, and 81 ± 4%, respectively, compared with 58 ± 5%, 70 ± 5%, 49 ± 5%,
39 ± 5%, and 93 ± 3% in Group-V. There were no significant differences in these end
points between groups regardless of insulin-dependency. Multivariable Cox proportional
hazards model identified age, left ventricular ejection fraction, renal failure, and
hyperlipidemia as independent predictors for all death, age and left ventricular ejection
fraction for cardiac death, sinus rhythm for both MACE and MACCE, and prior percutaneous
coronary intervention for re-revascularization.
Conclusions In our experience, complete arterial revascularization using LITA/RA “T-Grafts” does
not provide superior long-term clinical benefits for diabetic patients compared with
a combination of LITA and sequential vein graft.
Keywords
CABG - arterial revascularization - internal thoracic artery - radial artery - diabetes
mellitus
