Fellow in cardiac surgery Montreal Heart Institute Montreal, Quebec, Canada
Background: Diabetes is a known risk factor that affect long-term life expectancy after coronary artery revascularisation. Little data exist on long-term MACE (major adverse cardiac event) free survival in diabetic patients after OPCAB surgery. MACE have been reported to increase with aging in the diabetic population. We report our 20 year-follow-up experience with OPCAB surgery in diabetic (DM) patients in relation to age at the time of surgery.
METHODS AND RESULTS: Between September 1996 and January 2010, 1600 consecutive patients underwent OPCAB surgery at the Montreal Heart Institute, representing 98% of the time frame case load, single surgeon experience. Among them 1392 had complete long-term MACE follow-up. Follow-up was completed up to May 2025. MACE were described as cardiac death, hospitalisation for new myocardial infarction, cardiac failure, unstable angina, percutaneous coronary angioplasty or new surgical revascularisation. Average follow-up period was 153+69 months (median: 164 months). Patient’s mean age was 64+9.9 years, 29.4% were diabetics and 33% were >65 years old. At twenty years, Kaplan Meier MACE-free survival was decreased in DM patients (52.5+2.9% vs 44.9+4%, p< 0.001). When dichotomized between patients < 65 and ≥ 65 years old, diabetes affected MACE-free survival equally between young and old patients. After correcting for demographics and risk factors, diabetes, cardiac insufficiency (NYHA ≥III/IV), obesity, peripheral vascular disease, mitral insufficiency (≥2+), single ITA use, and incomplete revascularisation were significant risk factors for MACE occurrence. Age at the time of surgery was not a significant factor (p=0.3).
Conclusion: According to the current series, diabetes significantly affected MACE-free 20-year survival in patients who underwent OPCAB surgery. The use of Bilateral ITA and completeness of the revascularisation prevented MACE occurrence. There was no interaction between age and diabetes.
