Evidence map›Paper›PMID 37741811›Full record

Trial reportClinical research in cardiology : official journal of the German Cardiac Society2024

Influence of diabetes and obesity on ten-year outcomes after coronary artery bypass grafting in the arterial revascularisation trial.

Maria Stefil, Mario Gaudino, Umberto Benedetto, Stephen Gerry, Alastair Gray, Belinda Lees, Bruno Podesser, Lukasz Krzych, Lokeswara Rao Sajja, David Taggart and 2 more

Abstract readRandomized Controlled TrialMulticenter Study
PubMed Publisher
In one paragraph

Trial report in Clinical research in cardiology : official journal of the German Cardiac Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.0field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 3 citations in OpenAlex.

  1. Review
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 9 institutions in 5 countries.

Maria StefilNorwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK. maria.stefil@gmail.com.ORCID http://orcid.org/0000-0001-7137-2459
Mario GaudinoDepartment of Cardiothoracic Surgery, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, USA.
Umberto BenedettoSchool of Clinical Sciences, University of Bristol and Bristol Royal Infirmary, Bristol, UK.
Stephen GerryCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
Alastair GrayHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Belinda LeesNuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Bruno PodesserLandesklinikum, St. Polten and Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.
Lukasz KrzychDepartment of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
Lokeswara Rao SajjaDivision of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India.
David TaggartNuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Marcus FlatherNorwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.
ART Investigators
John Radcliffe Hospital · GBUniversity of East Anglia · GBApollo Hospitals · INBristol Royal Infirmary · GBMedical University of Silesia · PLNewYork–Presbyterian Hospital · USNuffield Orthopaedic Centre · GBUniversitätsklinikum St. Pölten · ATUniversity of Oxford · GB

Funding

Medical Research Council G0200390
6 · The paper itself

Abstract

aimsDiabetes and obesity are common conditions which can influence outcomes after coronary artery bypass graft (CABG) surgery. The aim of this study was to evaluate the influence of diabetes and obesity, and their interactions, on ten-year outcomes following CABG. METHODS AND

resultsPatients enrolled in the Arterial Revascularisation Trial (ART) were stratified by diabetes and obesity at baseline. Diabetes was further stratified into insulin and non-insulin dependent. The primary outcome was all-cause mortality at 10 years of follow-up. Secondary outcomes were the composite of all-cause mortality, myocardial infarction or stroke at 10 years, and sternal wound complications at 6 months follow-up. A total of 3096 patients were included in the analysis (24% with diabetes, 30% with obesity). Patients in the "diabetes/no obesity" group had a higher risk of all-cause mortality following CABG (adjusted hazard ratio [aHR] 1.33, 95% confidence interval [CI] 1.08-1.64, p = 0.01) compared to the reference group of "no diabetes/no obesity". No excess risk was observed in the "no diabetes/obesity" or "diabetes/obesity" groups. Patients with insulin dependent diabetes had a significantly higher ten-year mortality risk compared to no diabetes (aHR 1.85, 95% CI 1.41-2.44, p = 0.00). Patients in the "diabetes/no obesity" and "diabetes/obesity groups" had a higher risk of sternal wound complications (HR 2.29, 95% CI 1.39-3.79, p < 0.001 and HR 3.21, 95% CI 1.89-5.45, p < 0.001 respectively). The composite outcome results were consistent with the mortality results.

conclusionDiabetes, especially insulin dependent diabetes, is associated with a higher ten-year mortality risk after CABG, in contrast to obesity which does not appear to increase long term mortality compared to non-obese. The interaction between diabetes and obesity shows an apparent "protective" effect of obesity irrespective of diabetes on mortality. Both conditions are associated with a higher risk of post-operative sternal wound infections.

Indexed as

Coronary Artery BypassCoronary Artery DiseaseObesityAgedCause of DeathDiabetes MellitusFemaleFollow-Up StudiesHumansMaleMiddle AgedPostoperative ComplicationsRisk AssessmentRisk FactorsSurvival RateTime FactorsArterial revascularisation trialCoronary artery bypass graftingCoronary artery diseaseDiabetesObesityObesity paradox

Identifiers

PMID37741811
OpenAlexW4386986029

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.