44. Multiple Arterial versus Single Arterial Grafting in Patients with Diabetes Undergoing Coronary Artery Bypass Surgery

Objective:
Data on long-term outcomes in patients with diabetes receiving multi-arterial grafting (MAG) vs. single arterial grafting (SAG) are limited.
The objective of this study is to compare long-term outcomes between MAG and SAG for coronary artery bypass graft surgery (CABG) in diabetic patients.

Methods:
A total of 24,944 patients with diabetes who underwent CABG (2,955 MAG and 21,989 SAG procedures) between 2000-2016 were identified using New Jersey State mandatory clinical registry linked with death records and hospital discharge data (last follow-up 12/31/2019). Emergent salvage, re-operative and concomitant valve procedures were excluded.
Patients were matched by propensity score. Cox proportional hazards model was used to investigate long-term survival and competing risk analysis for secondary outcomes.

Results:
In patients with diabetes undergoing coronary artery bypass surgery, the rates of multi-arterial grafting procedures utilized by surgeons decreased from 20% to 8% between 2000 and 2016. Diabetic patients receiving MAG were younger (61.88 vs. 66.71, P=<.0001), predominantly males, with a lower prevalence of hypertension, peripheral vascular disease, congestive heart failure, chronic lung disease, renal failure and dyslipidemia. The median follow-up time was 6.8 years.
Multi-arterial CABG was associated with a lower 10-year mortality compared to single arterial CABG in 2882 propensity-matched pairs (HR: 0.75, 95% CI: 0.68-0.83). MAG was also associated with lower risks of myocardial infarction (HR: 0.87, 95% CI: 0.80-0.95), repeat revascularization (HR: 0.86, 95% CI: 0.76-0.97) and composite outcome (HR: 0.79, 95% CI: 0.74-0.85). These results were confirmed in subgroup analyses of females, males, younger (age<70) and older patients (age≥70) with diabetes (Figure).

Conclusions:
Patients with diabetes benefit from receiving MAG over SAG; improved long-term survival, lower hazards of secondary and composite outcomes. Coordinated efforts are needed to offer MAG to diabetic patients.

Doaa Alsaleh (1), Eric Sun (2), Anas Alzahrani (1), Shinobu Itagaki (2), Joanna Chikwe (3), natalia egorova (1), (1) Icahn School of Medicine at Mount Sinai, New York, NY, (2) Mount Sinai Hospital, New York, NY, (3) Cedars-Sinai, Beverly Hills, CA

Rashmi Yadav

Invited Discussant

Ms Rashmi Yadav is Consultant Cardiac Surgeon at the Royal Brompton Hospital since November 2011. She completed her undergraduate training in Christian Medical College, Vellore, India and Cardiac Surgical training on the North West Thames London Rotation including The Royal Brompton, Heart, St George’s, Hammersmith and Harefield Hospitals. She holds a PhD from Imperial College, London. Ms Yadav completed a fellowship in Minimally Invasive Cardiac Surgery at the Robert Bosch Krankenhaus in Stuttgart, Germany. She also holds a certificate of advanced studies in Mitral and Tricuspid Structural Valve Interventions from University of Zurich.

Ms Yadav has specialist expertise in minimally invasive and open mitral valve repair and AF ablation. She has the largest UK experience of minimally invasive transcatheter beating-heart mitral valve repairs with NeoChord and is also experienced in TAVI, TMVI (Tendyne) and Harpoon procedures. Her other keen interest is coronary surgery including hybrid coronary revascularization, robotic-assisted, minimally invasive coronary artery bypass surgery (EndoACAB) and complex multiple arterial coronary artery bypass graft surgery and endoscopic conduit harvesting. Ms Yadav has special interest in ethnic and gender differences in IMA and coronary anatomy. In particular, she is an expert in heart disease in women, and has given international invited talks on this and several other topics including transcatheter mitral interventions. Ms Yadav is a member of the EACTS Mitral and Tricuspid Task Force and was part of the Task Force for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization.

Ms Yadav also has a keen interest in gender equality in cardiac surgery, leadership, human motivation and emotional intelligence at work. She is also involved in mentorship programmes for school and medical students. Ms Yadav is the adult cardiac representative for the SCTS Women In Cardiothoracic Surgery Working Group. She is married with two daughters.

Doaa Alsaleh

Abstract Presenter

Dr. Doaa Alsaleh  - a physician scientist from Saudi Arabia- graduated with an MD degree from Arabian Gulf University, Bahrain. After medical school, she completed her internship in clinical and research training in Bahrain and Scotland. She then joined Weill Cornell Medicine in New York where she finished a 2-year fellowship program in clinical research. After completing her training she joined Icahn School of Medicine at Mount Sinai Hospital in New York, received masters in the science of clinical research and is currently a PhD candidate in clinical research. Dr.Alsaleh has been designing, teaching & presenting outcomes research and clinical trials. She is currently working on multiple state registries in the area of cardiology: coronary artery bypass grafting outcomes.

Specialties: Adult Cardiac, Coronary, Anatomy and Conditions, Coronary, Coronary artery disease, Treatment/Procedure/Operation/Surgery, Coronary Disease, CABG