Short- and Long-term Prognostic Impacts of Diabetes Mellitus in Patients Undergoing Off-pump Coronary Artery Bypass Grafting with Skeletonized Internal Thoracic Artery Graft.

Objectives: Diabetes mellitus (DM) is a widely recognized risk factor for adverse outcomes after coronary artery bypass grafting (CABG). This study aimed to reassess the impact of DM on the short- and long-term outcomes of patients undergoing CABG using skeletonized internal thoracic artery (ITA) grafts. Materials: This retrospective analysis included 2,737 consecutive patients who underwent CABG between 2002 and 2020 at Juntendo University. The patients were divided into two groups based on the presence or absence of DM. Outcomes were analyzed for both short- and long-term periods to evaluate the prognostic impact of DM. Results: Mean follow-up was 7.1 ± 4.9 years. Diabetic patients had a higher prevalence of coexisting diseases and impaired preoperative cardiac and renal function than non-diabetic patients. While short-term outcomes, including in-hospital mortality and deep sternal wound infection, were similar between the groups, patients with diabetes exhibited higher rates of postoperative complications, such as acute kidney injury. During long-term follow-up, patients with diabetes had significantly poorer outcomes, including higher all-cause mortality, cardiac mortality, and major adverse cardiac and cerebrovascular events (MACCE). Conclusion: The use of skeletonized ITA grafts was not associated with an increased incidence of deep sternal wound infection (DSWI), even in patients with diabetes. DM remains a strong risk factor for both short- and long-term adverse outcomes in patients who undergo CABG. These findings emphasize the need for improved perioperative and long-term management of patients with diabetes to achieve better CABG outcomes.