Multiple arterial grafting in CABG reduce long-term mortality in diabetes patients

UK: In a new study published in the European Heart Journal, it was shown that compared to single arterial grafting (SAG), multiple arterial grafting (MAG) relatively reduced mortality and major adverse cardiac events (MACE) rates after coronary artery bypass grafting (CABG) up to 10 years. 

Despite significant breakthroughs in medical care, coronary artery disease (CAD) has long been recognized as a major source of morbidity and death in people with diabetes mellitus (DM). In individuals with diabetes and multi-vessel coronary disease, CABG has proven to be a better approach of revascularization when compared to percutaneous coronary intervention. As a result, David P. Taggart and colleagues conducted a post-hoc examination of the influence of MAG on CABG outcomes based on diabetes status in the Arterial Revascularization Trial (ART).

At a 10-year follow-up, the primary objective was all-cause death, and the secondary endpoint was a composite of major adverse cardiac events (MACE). Patients were divided into two groups based on their diabetes condition (non-DM and DM) and grafting method (MAG vs. SAG). The study comprised 3020 participants, with 716 (23.7%) having diabetes. In all, 55.8% of non-DM patients were given MAG and 44.2% were given SAG, whereas 56.6% of DM patients were given MAG and 43.4% were given SAG.

The key findings of this study were as follows:

1. When compared to SAG, the usage of MAG was related to reduced 10-year mortality in both DM and non-DM patients.

2. The rate of 10-year MACE was similarly lower for MAG compared. SAG in both groups.

3. Deep sternal wound infections (DSWIs) were infrequent overall, but more prevalent in the MAG group compared to the SAG group in both non-DM (3.3 vs. 2.1%) and DM patients (7.9 vs. 4.8% ).

4. The insulin-treated individuals receiving MAG had the greatest prevalence of DSWI (9.6 vs. 6.3%, when compared with SAG).

In conclusion, MAG was linked with significantly decreased death rates at 10 years post coronary artery bypass grafting in diabetic patients in this post-hoc analysis of the ART. Patients with DM who were given MAG had a greater risk of developing DSWI, especially if they were insulin-dependent.

Reference:

Taggart, D. P., Audisio, K., Gerry, S., Robinson, N. B., Rahouma, M., Soletti, G. Jr., Cancelli, G., Benedetto, U., Lees, B., Gray, A., Stefil, M., Flather, M., Gaudino, M., Taggart, D., Ratnatunga, C., Westaby, S., Cook, J., Wallis, C., … Wos, S. (2022). Single versus multiple arterial grafting in diabetic patients at 10 years: the Arterial Revascularization Trial. In European Heart Journal. Oxford University Press (OUP). https://doi.org/10.1093/eurheartj/ehac199