Metabolic syndrome increases operative mortality in patients undergoing coronary artery bypass grafting surgery (original) (raw)
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2010
The aim of this study was to determine the impact of the metabolic syndrome (MS) on operative mortality after a coronary artery bypass grafting surgery (CABG). Background Diabetes and obesity are highly prevalent among patients undergoing CABG. However, it remains unclear whether these factors have a significant impact on operative mortality after this procedure. We hypothesized that the metabolic abnormalities associated with MS could negatively influence the operative outcome of CABG surgery. Methods We retrospectively analyzed the data of 5,304 consecutive patients who underwent an isolated CABG procedure between 2000 and 2004. Of these 5,304 patients, 2,411 (46%) patients met the National Cholesterol Education Program-Adult Treatment Panel III criteria for MS. The primary end point was operative mortality. Results The operative mortality after CABG surgery was 2.4% in patients with MS and 0.9% in patients without MS (p Ͻ 0.0001). The MS was a strong independent predictor of operative mortality (relative risk 3.04 [95% confidence interval (CI) 1.73 to 5.32], p ϭ 0.0001). After adjusting for other risk factors, the risk of mortality was increased 2.69-fold (95% CI 1.43 to 5.06; p ϭ 0.002) in patients with MS and diabetes and 2.36-fold (95% CI 1.26 to 4.41; p ϭ 0.007) in patients with MS and no diabetes, whereas it was not significantly increased in the patients with diabetes and no MS. Conclusions This is the first study to report that MS is a highly prevalent and powerful risk factor for operative mortality in patients undergoing a CABG surgery. Thus, interventions that could contribute to reduce the prevalence of MS in patients with coronary artery disease or that could acutely modify the metabolic perturbations of MS at the time of CABG might substantially improve survival in these patients.
Cardiovascular Journal Of Africa, 2012
Background: The individual components of the metabolic syndrome are risk factors for coronary artery disease. The underlying pathophysiology of a low-grade inflammatory process postulates that the metabolic syndrome could compromise a procedure such as coronary artery bypass graft surgery (CABG) done on cardiopulmonary bypass (CPB). Methods: From a single institution, 370 patients with the metabolic syndrome (IDF and ATP III criteria) and 503 patients without the metabolic syndrome were identified. The influence of the metabolic syndrome on the pre-operative core risk factors for CABG mortality as well as its effect on the mortality and major morbidity post surgery were investigated. Results: Patients with the metabolic syndrome were operated on less urgently than those without the metabolic syndrome. The EuroSCORE was also lower in those with the metabolic syndrome. Patients with the metabolic syndrome required fewer units of homologous red blood cells, but stayed statistically longer in hospital. Conclusions: In this surgical population the metabolic syndrome had no detrimental clinical effect on either the pre-operative risk factors or the outcome after CABG.
Associations of metabolic syndrome and diabetes mellitus with 16-year survival after CABG
Cardiovascular Diabetology, 2014
Background: The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) have not been extensively evaluated. The aim of the present study was to assess the impact of MetS and DM on the 16-year survival after CABG. Methods: Diabetic and metabolic status together with relevant cardiovascular data was established in 910 CABG patients operated in 1993-94. They were divided in three groups as follows: neither DM nor MetS (375 patients), MetS alone (279 patients) and DM with or without MetS (256 patients). The 16-year follow-up of patient survival was carried out using national health databases. The relative survival rates were analyzed using the Life comparing the observed survival rates of three patient groups to the rates based on age-, sex-and time-specific life tables for the whole population in Finland. To study the independent significance of MetS and DM for clinical outcome, multivariate analysis was made using an optimizing stepwise procedure based on the Bayesian approach.
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.
Journal of Diabetes, Metabolic Disorders & Control, 2018
Globally, the number of patients with diabetes mellitus (DM) has increased to almost 451 million in 2017 and has become a worldwide epidemic. Even more worrisome is that 49.7% of them remain undiagnosed. 1 Studies have shown that coronary artery disease (CAD) is the principal cause of mortality in DM patients and linked with significantly higher cardiovascular mortality due to myocardial infarction and stroke. 2,3 DM has always been a major risk predictor for unfavourable outcomes in patients undergoing cardiac revascularization either percutaneous coronary intervention (PCI) 4 or coronary artery bypass grafting (CABG), 5,6 surgery. Methods We performed a single-centre retrospective study on the validation of EuroSCORE II among 1718 patients undergoing CABG surgery at the National Heart Institute (IJN) of Kuala Lumpur from 1st January to 31st December 2016. EuroSCORE II is a risk evaluation tool that included ten patient-related factors, five cardiac-related factors, and three operation-related factors with the aim of determining in-hospital mortality after cardiac surgery. Patient-related factors include age (year), gender (male /female), renal impairment (creatinine clearance), extra cardiac arteriopathy, poor mobility, previous cardiac surgery, chronic lung disease, active endocarditic, critical preoperative state and diabetes on insulin. Cardiac-related factors include the New York Heart Association (NYHA) stages, Canadian Cardiovascular Society (CCS) class 4 angina, Left Ventricular (LV) function (ejection fraction >50%, 31-50%, 21-30%, <20%), recent myocardial infarction (MI) (within 90 days) and pulmonary hypertension (31-55mm Hg / >55mm Hg). Operation-related factors include urgency (elective, urgent, emergency, salvage), weight of the intervention (isolated CABG, isolated single non-CABG, 2-procedures, and 3-procedures)
Research in Cardiovascular Medicine, 2014
Background: The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension. Objectives: The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG). Patients and Methods: This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P < 0.001). The most prevalent complications were bleeding [20 (8.5%)] and dysrhythmia [18 (7.7%)]. At three months follow-up, the frequency rates of readmission [24 (10.2%)] and mediastinitis [9 (3.8%)] were higher than other complications. Diabetes and MetS were risk factors for a long ICU stay (> 5 days) and atelectasia (P < 0.05). Significant associations were observed between diabetes and pulmonary embolism (P = 0.025) and mediastinitis (P = 0.051). Conclusions: Identification of MetS before CABG can predict the surgery outcome. Patients with MetS have increased risks for longer ICU stay and atelectasia.
Changes Over Time in Risk Profiles of Patients Who Undergo Coronary Artery Bypass Graft Surgery
JAMA Surgery, 2015
IMPORTANCE Today's coronary artery bypass grafting (CABG) population appears to comprise sicker patients than in the past; however, little is known about the change in the risk profile. OBJECTIVE To evaluate the change with time in the risk profile of patients who undergo CABG. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of records from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP); 65 097 patients who underwent isolated primary CABG from October 1, 1997, to April 30, 2011, were evaluated. MAIN OUTCOMES AND MEASURES Trends in risk profiles, surgical volume, and modern outcomes in the VA system. We determined the significance of changes in age and major comorbidities across time with simple linear regression analysis and evaluated the rates of perioperative mortality (30-day or in-hospital) and VASQIP predicted risk of mortality trends over time. RESULTS From 1997 to 2011, there were increases in mean (SD) patient age (63.1 [9.4] vs 64.3 [7. 8] years; R 2 = 0.34; P = .02) and body mass index (28.3 [5.1] vs 30.1 [5.8]; R 2 = 0.95). There were also increases in the prevalence of diabetes mellitus (32.8% vs 41.3%; R 2 = 0.82), preoperative New York Heart Association (NYHA) class III or IV heart failure status (14.3% vs 34.2%; R 2 = 0.74), and left main coronary artery disease (26.0% vs 32.8%; R 2 = 0.82) (all P < .001). There was a decrease in the prevalence of advanced angina severity (Canadian Cardiovascular Society class III or IV) (R 2 = 0.95), previous myocardial infarction (R 2 = 0.82), and low ejection fraction (Յ34%) (R 2 = 0.88) (all P< .05). There was no significant change in the prevalence of cerebrovascular and peripheral vascular disease, chronic obstructive pulmonary disease, or 3-vessel coronary artery disease. Perioperative mortality rates and the VASQIP predicted risk of mortality, respectively, decreased with time (3.2% and 3.1% vs 1.7% and 1.6%). From 2004 to 2011, there was a significant increase in the prevalence of previous percutaneous coronary intervention (18.6% to 29.2%; R 2 = 0.82; P = .002). Overall CABG volume decreased (5551 in 1998 vs 3857 in 2012; R 2 = 0.95; P< .001). CONCLUSIONS AND RELEVANCE From 1997 to 2011, there was a progressive increase in the prevalence of obesity, diabetes, left main coronary artery disease, and advanced NYHA heart failure class among VA patients undergoing CABG. The prevalence of previous myocardial infarction, low ejection fraction, and advanced angina decreased, perhaps because of earlier surgical referral, improvement in medical management, or a shift in patient selection for CABG. Operative mortality also decreased with time. These trends confirm the general perception of significant, ongoing improvement in the care of patients who undergo CABG in the VA, despite an older, sicker population.
Metabolic Syndrome Affects Midterm Outcome After Coronary Artery Bypass Grafting
The Annals of Thoracic Surgery, 2012
Background. Metabolic syndrome (MetS) is frequently associated with coronary artery disease, but data on the impact of MetS on long-term outcome of patients undergoing coronary artery bypass grafting are still lacking. The aim of the present study was to assess the effect of MetS on mortality and morbidity late after coronary artery bypass grafting.
Clinical Cardiology, 2012
Background: Significant advances in surgical techniques and postsurgical care have been made in the last 10 years. The goal of this study was to evaluate any decline in the age-adjusted in-hospital mortality rate of patients undergoing coronary artery bypass grafting (CABG) using a national database from 1989 to 2004 in the United States. Hypothesis: Reduction in CABG related mortality in recent years. Methods: Using the Nationwide Inpatient Sample (NIS) database, we obtained specific ICD-9-CM codes for CABG to compile the data. To exclude nonatherosclerotic cause of coronary disease, we studied only patients older than 40 years. We calculated total and age-adjusted mortality rate per 100,000 for this period. Results: The NIS database contained 1 145 285 patients who had CABG performed from 1988 to 2004. The mean age for these patients was 71.05 ± 9.20 years. From 1989, the age-adjusted rate for all CABG-related mortality has been decreasing steadily and reached the lowest level in 2004: 300.3 per 100 000 in 1989, (95% confidence interval [CI], 20.4-575.9) and 104.69 per 100 000 (95% CI, 22.6-186.7) in 2004. Total death also declined from 5.5% to 3.06%. This decline occurred irrespective of comorbidities such as congestive heart failure, diabetes, or acute myocardial infarction, albeit increasing the number of CABG procedures performed in high-risk patients. Conclusions: The age-adjusted in-hospital mortality rate from CABG has been declining steadily and reached its lowest level in 2004, irrespective of comorbidities. This decline most likely reflects advances in surgical techniques and the use of evidence-based medicine in patients undergoing CABG.