Single Arterial versus Multiple Arterial Grafting in 3,164 Diabetic Patients Undergoing Coronary Artery Bypass Surgery: A Propensity-Matched Analysis.

Abstract

Diabetic patients undergoing coronary artery bypass grafting (CABG) are at increased risk of adverse outcomes, yet the role of multiple arterial grafting (MAG) remains underutilized and understudied in this population. The objective of this study was to evaluate short-term safety and long-term survival outcomes of MAG compared with single arterial grafting (SAG) in diabetic patients, using a propensity-matched design. This retrospective single center study included 3,164 diabetic patients who underwent isolated CABG between January 1996 and September 2023, stratified by graft strategy: SAG (n = 2,499) and MAG (n = 665). Propensity score matching was applied to balance baseline differences, yielding 662 matched pairs. In the unmatched cohort, MAG was associated with a significantly higher number of grafts and a greater rate of deep sternal wound infection (3.0% vs 1.7%; p = .028), while 30-day mortality was comparable (2.7% vs 2.8%; p = .939). In the matched cohort, short-term outcomes did not differ significantly between groups (p > .3 for all). Kaplan-Meier survival estimates showed comparable survival (p = .954) at 1 year (92% vs 91%), 5 years (85% vs 83%), 10 years (73% vs 73%), 15 years (57% vs 62%), and 20 years (44% vs 41%). Multivariate Cox regression identified age, female sex, New York Heart Association class, prior cardiac surgery, reduced ventricular function, and disease extent as independent predictors of mortality. In conclusion, these findings suggest that MAG can be safely offered to diabetic patients, though its long-term survival benefit remains uncertain.