• Zhizhao Song, Liuzhong Shen, Zhe Zheng, Bo Xu, Hui Xiong, Lihuan Li, and Shengshou Hu.
• Department of Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
• J. Thorac. Cardiovasc. Surg. 2016 Jun 1; 151 (6): 1695-1701.e1.

ObjectivesTo compare in-hospital and midterm outcomes after one-stop hybrid coronary revascularization (HCR) and off-pump coronary artery bypass (OPCAB) in patients with diabetes mellitus (DM).MethodsThe series included 120 patients with DM who underwent one-stop HCR at Fuwai Hospital between June 2007 and September 2014. These patients were 1:2 matched with 240 patients who underwent OPCAB using propensity score matching. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and secondary endpoints were in-hospital outcomes. Accounting for matched-pairs design, the survival analysis was evaluated with a marginal Cox model, and the continuous and dichotomous variables of in-hospital outcomes were compared with the Wilcoxon signed-rank test and a logistic regression model using generalized estimating equations, respectively.ResultsCompared with OPCAB, one-stop HCR was associated with less chest tube drainage (median, 748 mL [interquartile range (IQR), 540-1080 mL] vs 990 mL [IQR, 730-1250 mL]; P < .001), a lower packed red blood cell transfusion rate (18.3% vs 29.6%; P = .032), shorter mechanical ventilation time (median, 13.7 hours [IQR, 10.3-16.9 hours] vs 16.8 hours [IQR, 13.0-19.6 hours]; P < .001), and shorter stay in intensive care unit (median 21.7 hours [IQR, 19.0-44.3 hours] vs 46.7 hours [IQR, 24.3-72.7 hours]; P < .001). Over 30 months of follow-up, one-stop HCR and OPCAB had a similar rate of MACCE (7.4% vs 8.0% at 3 years; hazard ratio, 0.807; 95% confidence limit, 0.352-1.849; P = .612), but one-stop HCR had a lower stroke rate (0% vs 3.6% at 3 years; P = .046).ConclusionsFor selected patients with DM, one-stop HCR provided safe and reproducible revascularization, with less perioperative invasiveness and similar and favorable midterm outcomes compared with OPCAB.Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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