Coronary artery bypass revascularization using bilateral internal thoracic arteries in diabetes patients: a systematic review and meta-analysis

Objective: Internal thoracic artery is an excellent graft regarding long-term results and patency in coronary artery bypass surgery (CABG). Use of bilateral internal thoracic artery (BITA) for diabetes patients remains low because of concerns for increased risk of wound infection. However, several recent studies revealed that usage of bilateral internal thoracic arteries (BITA) is not associated with risk of wound infection among diabetes patients since skeletonized ITA harvesting was used. We aimed to assess effects of BITA in diabetes patients after CABG.
Methods: The following sources were searched: MEDLINE via PubMed (from 1995 to December 2014), EMBASE, and the Cochrane Library database (Cochrane Central Register of Controlled Trials) for studies comparing single internal thoracic artery (SITA) vs. BITA for diabetes patients.
Results: After searching of electronic databases, six studies with 2817 patients were identified. All-cause death occurred in 3.3% with SITA and 3.6% with BITA (odds ratio [OR], 0.92; 95% confidence interval [CI] = 0.60 to 1.40; p=0.76). The incidence of myocardial infarction was 2.6% with SITA and 3.8% with BITA (OR, 0.67; 95% CI = 0.43 to 1.05; p=0.10). Target vessel revascularization occurred in 5.1% with SITA and 11.7% with BITA (OR, 0.40; 95% CI = 0.29 to 0.55; p < 0.0001). Major adverse cardiac and cerebrovascular events (MACCE) occurred in 10.7% with SITA and 15.7% with BITA (OR, 0.40; 95% CI = 0.29 to 0.55; p < 0.0001). Conclusion: Among the patients with most severe atheroscrelogenic properties who had diabetes and multivessel coronary artery disease, the revascularization using BITA markedly improved remote outcomes after CABG when compared to SITA.