Late outcomes of off-pump versus on-pump coronary bypass in patients with diabetes: A nationwide study from Taiwan.

Objectives: Although the benefits and risks of on- and off-pump coronary artery bypass have been compared in several clinical trials, large-scale studies regarding long-term outcomes in patients with diabetes are lacking. We compared long-term outcomes after on- and off-pump coronary artery bypass in patients with diabetes. Methods: We evaluated outcomes in 16,215 patients with diabetes who underwent isolated coronary artery bypass from 2000 to 2011. Clinical data validity was regulated by the single-payer, universal, and nationwide reimbursement systems. Long-term outcomes were compared using propensity score matched analyses. Results: Off-pump surgery was associated with a greater incidence of repeat revascularization (P = .0036) in the long term. Propensity score matching identified 3796 patients in each group. There were no significant differences between on- and off-pump surgery regarding the long-term risks of mortality (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.87-1.02, P = .1667), stroke (HR, 0.97; 95% CI, 0.87-1.09, P = .6074), and myocardial infarction (HR, 1.05; 95% CI, 0.91-1.20, P = .5207). Off-pump surgery offered a survival benefit within 30 days (HR (on vs off), 1.52, 95% CI, 1.24-1.85, P < .0001). In patients with diabetes and end-stage renal disease, on- pump surgery provided a significant long-term survival benefit (HR (on vs off), 0.68, 95% CI, 0.51-0.91). Conclusions: In patients with diabetes undergoing isolated coronary artery bypass, off-pump surgery provided a 30-day benefit in mortality, but both groups had similar long-term survival. In off-pump surgery, repeat revascularization was a concern in the long term. In patients with diabetes and end-stage renal disease, on- pump surgery has long-term survival benefits.