Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery (original) (raw)
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Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting
The Annals of Thoracic Surgery, 1999
Diabetes mellitus is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting. The impact of diabetes on short- and longterm follow-up after coronary artery bypass grafting was studied by comparing the outcomes between 9,920 patients without diabetes mellitus and 2,278 patients with diabetes from 1978 to 1993. Compared with nondiabetic patients, the group with diabetes was older (62+/-10 years versus 60+/-10 years), comprised more women (31% versus 19%), had a greater incidence of hypertension (61% versus 44%) and previous myocardial infarction (51% versus 48%), had class III-IV angina more commonly (69% versus 63%), showed a higher incidence of congestive heart failure (11% versus 5%) or triple-vessel or left main disease (60% versus 50%), and had lower ejection fractions (0.54 versus 0.57) (all, p< or =0.05). Diabetic patients had a higher incidence of postoperative death (3.9% versus 1.6%) and stroke (2.9% versus 1.4%) (both, p< or =0.05), but not Q wave myocardial infarction (1.8% versus 2.9%). Diabetics had lower survival (5 years, 78% versus 88%; 10 years, 50% versus 71%; both, p< or =0.05) and lower freedom from percutaneous transluminal coronary angioplasty (5 years, 95% versus 96%; 10 years, 83% versus 86%; latter, p< or =0.05), but diabetics did not have lower freedom from either myocardial infarction (5-years, 92% versus 92%; 10-years, 80% versus 84%) or additional coronary artery bypass grafting (5-years, 98% versus 99%; 10-years, 90% versus 91%). Multivariate correlates of long-term mortality were diabetes, older age, reduced ejection fraction, hypertension, congestive heart failure, number of vessels diseased, and urgent or emergent operation. Diabetics have a worse hospital and longterm outcome after coronary artery bypass grafting. The increased risk in such patients can only partially be explained by other demographic characteristics.
The Journal of Thoracic and Cardiovascular Surgery, 2009
We sought to compare mortality after coronary artery bypass grafting in patients with and without diabetes mellitus undergoing operations during different time periods. We performed analyses of 12,415 primary isolated coronary artery bypass grafting operations performed during 1970-2003, with follow-up of 5-year mortality up to December 2006. The prevalence of diabetes mellitus continuously increased up to 25% among patients undergoing coronary artery bypass grafting in 2003. The 1892 patients with type 2 diabetes mellitus were older, more often female, and more frequently had cardiovascular risk factors, acute coronary syndrome, 3-vessel disease, and severely reduced left ventricular function than patients without diabetes mellitus. Early mortality was 3.4% in patients with diabetes mellitus versus 1.8% in patients without diabetes mellitus. The multivariable adjusted odds ratio was 2.0, and the 95% confidence interval was 1.4 to 2.7. Early adjusted mortality was significantly lower in patients operated on during 2000-2003 than those operated on during 1970-1989 in patients with diabetes mellitus (odds ratio, 0.3; 95% confidence interval, 0.1-0.9) and without diabetes mellitus (odds ratio, 0.4; 95% confidence interval, 0.2-0.7). Mortality until 5 years was 14.6% in patients with diabetes mellitus versus 8.3% in patients without diabetes mellitus (hazard ratio, 1.8; 95% confidence interval, 1.5-2.0). Five-year mortality was reduced by 40% in patients operated on during 2000-2003 compared with that seen in those operated on during 1970-1989 in patients with and without diabetes mellitus. Diabetes mellitus was associated with an almost 2-fold increased risk of early and 5-year mortality. Early and late mortality were substantially reduced in patients with and without diabetes mellitus operated on more recently, but the mortality disadvantage associated with diabetes mellitus was not eliminated.
Interactive cardiovascular and thoracic surgery, 2007
The outcome of coronary artery bypass grafting (CABG) in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing contemporary CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. We retrospectively analyzed prospectively collected data of 2725 CABG patients from January 1998 to December 2005: one thousand and eighty-five (40%) diabetics and 1640 (60%) non-diabetics [mean age 65+/-11 years, 1882 (69%) male]. Subgroup analysis was performed for two study periods (1998-2002 vs. 2003-2005). The overall hospital mortality was 1.8% [n=50; diabetics: 2.4%, non-diabetics: 1.5% (P=0.07)]. The mortality rate among diabetics decreased from 3.1% in 1998-2002 to 1.0% in 2003-2005 (P=0.021). Diabetes was not an independent predictor of hospital mortality but predicted the occurrence of deep sternal wound infection (OR=3.77). Diabetes si...
Journal of the American College of Cardiology, 2015
Patients with diabetes mellitus (DM) have an increased risk of adverse outcomes after coronary artery bypass grafting (CABG). Previous studies have reported prognosis in relation to treatment with or without insulin, and not to the type of diabetes. This study investigated long-term survival in patients with type 1 DM (T1DM) and type 2 DM (T2DM) following CABG. We included all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent primary isolated CABG in Sweden during 2003 through 2013. We identified patients with T1DM or T2DM in the Swedish National Diabetes Register. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality in patients with T1DM or T2DM. In total, 39,235 patients were included, of whom 725 (1.8%) had T1DM and 8,208 (21%) had T2DM. Patients with TDM1 were younger (59 vs. 67 years), had reduced ki...
European Journal of Cardio-Thoracic Surgery, 2010
Objective: Long-term outcome after coronary artery bypass grafting is worse in diabetic than in non-diabetic patients. No data are currently available regarding survival rates of diabetic and non-diabetic patients after coronary revascularisation compared with cohorts from the general population in the Netherlands, which were matched for age and sex (normal Dutch survival). Methods: We retrospectively analysed the data from 10 626 patients who underwent coronary artery bypass grafting between January 1998 and December 2007. Of these, 8287 patients were nondiabetic, 1587 were non-insulin-dependent and 630 were insulin-dependent diabetic patients (122 patients were lost to follow-up). Survival of these patient groups was compared with the normal Dutch survival. Results: Multivariate analyses revealed non-insulin-dependent diabetes to be a risk factor for early mortality and both insulin-dependent and non-insulin-dependent diabetes as risk factors for late mortality. The 1-, 5-and 10-year survival rates for non-diabetic patients were 94.1% AE 0.3%, 86.8% AE 0.4% and 75.1% AE 1.7%, respectively, which was better than the normal Dutch survival. For insulin-dependent diabetic patients, 1-, 5-and 10-year survival rates were 90.3% AE 1.2%, 78.0% AE 2.0% and 60.5% AE 4.6%, respectively, and for non-insulin-dependent diabetic patients 91.4% AE 0.7%, 79.0% AE 1.3% and 58.9% AE 3.4%, respectively, which was worse than the normal Dutch survival. Conclusions: Non-insulin-dependent diabetes was a risk factor for early mortality and both types of diabetes were risk factors for late mortality after revascularisation. Compared with age-and sex-matched cohorts from the general Dutch population, the 10-year survival of non-diabetic patients was better; whereas the survival of both types of diabetic patients was worse.
PubMed, 2013
Background: This study was conducted to determine whether Diabetes Mellitus (DM) is a predictor of short term mortality ; morbidity, or early readmission to hospital after Coronary Artery Bypass Graft (CABG). Methods: We analyzed a large cohort of 952 patients who had undergone isolated CABG. The preoperative, intera operative and postoperative risk factors as well as the complications and 30-day mortality rates were compared between the diabetics and non-diabetics. Among the 952 patients; 734 ones (77.1%) were in non-diabetic group and 218 (22.9%) were diabetics. Results: Having DM did not increase the risk of 30-day mortality. In addition, DM did not affect the major complications; arrhythmia, Myocardial Infarction(MI), infective complications, neurological complications, Pulmonary Embolism (PE) except renal complications that was higher in the diabetics (5.5% vs 1.4%; P<0.001, OR=4.2) However reoperation for bleeding was higher in non-diabetic patients (7.9% vs 4.6%; P=0.009, OR=1.7). Nevertheless ,no significant difference was observed between the two groups regarding mechanical ventilation time (hour), reintubation, length of ICU stay (day), length of hospital stay (day), and readmitting as postoperative variables. Conclusions: Except for renal complications, DM was not associated with adverse outcomes in the patients undergoing isolated CABG.