Bilateral versus unilateral internal mammary revascularization in patients with diabetes
Bilateral versus unilateral internal mammary revascularization in patients with diabetes
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DOI：
10.1161/01.cir.0000085995.87982.6e
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发表时间：
2003-09-16
期刊：
影响因子：
37.8
通讯作者：
Nishida, H
中科院分区：
文献类型：
--
作者：
Endo, M;Tomizawa, Y;Nishida, H
背景-这项历史性队列研究评估了双侧乳内动脉（比马）移植物在糖尿病患者冠状动脉旁路移植术（CABG）中的益处。方法和结果-我们在1131例患者中使用经皮乳内动脉（IMA）移植物进行了选择性、孤立性、原发性、多支CABG，其中467例（41.3%）患有2型糖尿病。比较了277例使用单一IMA（SIMA）移植物的糖尿病患者和190例使用比马移植物的糖尿病患者的早期和长期结果（中位随访时间为8.1年）。两组的住院死亡率相似。比马组的早期通畅率明显高于SIMA组（97.7%比93.8%，P = 0.0012）。SIMA和比马组的生存率无显著差异。与射血分数正常（大于0.4）的患者相比，射血分数低（0.4或更低）的患者的晚期心源性死亡率显著更高（P = 0.0001）。在射血分数保留的患者中，使用比马的10年生存率显著高于使用SIMA（87.8 ± 3.5%对比75.2 ± 3.4%，P = 0.04），比马组术后10年无死亡率、无再次CABG率、无再发心肌梗死率均显著高于SIMA组（86.6+/-3.6% vs 69.0+/-3.7%，P = 0.0086）。射血分数保留的患者中，比马组的所有死亡或重复CABG或复发性心肌梗死的风险比明显较低（0.53; 95% CI，0.31 ~ 0.9; P = 0.019）。结论-去离子比马移植物对射血分数保留的糖尿病患者的冠状动脉血运重建有益，但对射血分数降低的患者的生存益处有限部分归因于高心源性死亡率。
Background-This historical cohort study evaluated the benefit of bilateral internal mammary artery (BIMA) grafts in coronary bypass grafting (CABG) for patients with diabetes.Methods and Results-We performed elective, isolated, primary, multiple CABG using skeletonized internal mammary artery (IMA) grafts for multivessel disease in 1131 patients, 467 (41.3%) of whom had type 2 diabetes mellitus. The early and long-term results were compared between 277 patients with diabetes using single IMA (SIMA) grafts and 190 using BIMA grafts (median follow-up, 8.1 years). Hospital mortality was similar in both groups. Early patency rate of all grafts was significantly higher using BIMA than using SIMA (97.7% versus 93.8%, P = 0.0012). Survival rates were not significantly different between SIMA and BIMA groups. Late cardiac mortality was significantly higher in patients with low ejection fraction (0.4 or lower) compared with preserved ejection fraction (higher than 0.4) (P = 0.0001). In patients with preserved ejection fraction, 10-year survival rate was significantly higher using BIMA than using SIMA (87.8+/-3.5% versus 75.2+/-3.4%, P = 0.04), and 10-year all death-free or repeat CABG or recurrent myocardial infarction-free rate was significantly higher using BIMA than using SIMA (86.6+/-3.6% versus 69.0+/-3.7%, P = 0.0086). The hazard ratio for all death or repeated CABG or recurrent myocardial infarction in patients with preserved ejection fraction was markedly lower in the BIMA group (0.53; 95% CI, 0.31 to 0.9; P = 0.019).Conclusions-Skeletonized BIMA grafts are beneficial in coronary revascularization for diabetic patients with preserved ejection fraction but have limited survival benefit for those with reduced ejection fraction attributable to high cardiac mortality.