Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery

Background— The objective of this study was to identify the impact of diabetes and related comorbidities, namely chronic renal failure, peripheral vascular disease, and low ejection fraction (<35%), on long-term survival of patients undergoing coronary artery bypass graft surgery. Methods and Results— A unicenter study was conducted on 9125 survivors of isolated coronary artery bypass graft surgery between 1992 and 2002. There were 6581 nondiabetic patients and 2544 diabetics, including 1809 patients with noninsulin-dependent diabetes mellitus and 735 patients with insulin-dependent diabetes mellitus. Cardiac-specific survival at 5 and 10 years was lower in insulin-dependent diabetes mellitus compared with both nondiabetic mellitus patients and patients with noninsulin-dependent diabetes mellitus (P<0.0001). However, freedom from cardiac-related death was similar for patients with noninsulin-dependent diabetes mellitus and nondiabetes mellitus patients up to 6 years (P=0 0.08) after surgery and was significantly lower thereafter (P=0.004). Cardiac-specific survival after coronary artery bypass graft surgery in patients with one or more comorbidities was comparable (P=0.4) for both nondiabetes mellitus patients and patients with noninsulin-dependent diabetes mellitus, but was significantly lower for those requiring insulin therapy (P<0.0001). Noninsulin-dependent diabetes mellitus was not an independent predictor of long-term cardiac death (hazard ratio: 1.09, P=0.41); however, insulin-dependent diabetes mellitus, chronic renal failure, peripheral vascular disease, and low ejection fraction were all independent risk factors for late cardiac death (all P<0.0001). The impact of comorbidities on the long-term risk of cardiac death was similar for the 3 groups. Conclusions— Noninsulin-dependent diabetes is not an independent predictor of late cardiac death after coronary artery bypass graft surgery, because cardiac-related survival is similar to that of nondiabetic patients for 6 years after surgery. In diabetic and nondiabetic patients, cardiac survival is adversely affected by the need for insulin therapy and/or the presence and number of comorbidities such as chronic renal failure, peripheral vascular disease, and low ejection fraction.

[1]  G. Angelini,et al.  The effect of diabetes mellitus on patients undergoing coronary surgery: a risk-adjusted analysis. , 2006, The Journal of thoracic and cardiovascular surgery.

[2]  Lino Gonçalves,et al.  Diabetes and cardiovascular disease: the road to cardioprotection , 2005, Heart.

[3]  Isaac Kohane,et al.  Differences in Gene Expression Profiles of Diabetic and Nondiabetic Patients Undergoing Cardiopulmonary Bypass and Cardioplegic Arrest , 2004, Circulation.

[4]  W. Nugent,et al.  Effect of Diabetes and Associated Conditions on Long-Term Survival After Coronary Artery Bypass Graft Surgery , 2004, Circulation.

[5]  Jeffrey L Carson,et al.  Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. , 2002, Journal of the American College of Cardiology.

[6]  D. Wennberg,et al.  Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. Northern New England Cardiovascular Disease Study Group. , 2001, Journal of the American College of Cardiology.

[7]  G. O'connor,et al.  Risks of Morbidity and Mortality in Dialysis Patients Undergoing Coronary Artery Bypass Surgery , 2000, Circulation.

[8]  B. Howard,et al.  Diabetes and cardiovascular disease , 2000, Annual review of medicine.

[9]  J. Herlitz,et al.  Mortality, mode of death and risk indicators for death during 5 years after coronary artery bypass grafting among patients with and without a history of diabetes mellitus , 2000, Coronary artery disease.

[10]  B. Hoogwerf,et al.  Effects of aggressive cholesterol lowering and low-dose anticoagulation on clinical and angiographic outcomes in patients with diabetes: the Post Coronary Artery Bypass Graft Trial. , 1999, Diabetes.

[11]  E. Jones,et al.  Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. , 1999, The Annals of thoracic surgery.

[12]  J. Sowers,et al.  Diabetes and cardiovascular disease. , 1999, Diabetes care.

[13]  George C. Kaiser,et al.  CASS registry: Long term surgical survival , 1999 .

[14]  J. O’Keefe,et al.  The optimal mode of coronary revascularization for diabetics. A risk-adjusted long-term study comparing coronary angioplasty and coronary bypass surgery. , 1998, European heart journal.

[15]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[16]  A L Shroyer,et al.  The 1996 coronary artery bypass risk model: the Society of Thoracic Surgeons Adult Cardiac National Database. , 1998, The Annals of thoracic surgery.

[17]  R. Califf,et al.  Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. , 1997, Circulation.

[18]  James T. Willerson,et al.  Appointment of New Associate Editor for Circulation , 1996 .

[19]  Robert L. Frye,et al.  Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. , 1996, The New England journal of medicine.

[20]  J. Herlitz,et al.  Mortality and Morbidity in Diabetic and Nondiabetic Patients During a 2-Year Period After Coronary Artery Bypass Grafting , 1996, Diabetes Care.

[21]  J. Birkmeyer,et al.  The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. , 1995, Journal of vascular surgery.

[22]  A. J. Valente,et al.  Pathogenesis of the Atherosclerotic Lesion: Implications for diabetes mellitus , 1992, Diabetes Care.

[23]  M. di Mauro,et al.  Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease. , 2003, The Journal of thoracic and cardiovascular surgery.

[24]  S. Nakagawa,et al.  [Influence of diabetes mellitus and complications on long-term outcome of coronary artery bypass surgery]. , 2000, Journal of cardiology.

[25]  E. Blackstone,et al.  CASS Registry long term surgical survival. Coronary Artery Surgery Study. , 1999, Journal of the American College of Cardiology.

[26]  R. Califf,et al.  Coronary revascularization in diabetic patients: a comparison of the randomized and observational components of the Aypass Angioplasty Revascularization Investigation (BARI). , 1999, Circulation.

[27]  E. Jones,et al.  Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease. , 1998, Journal of the American College of Cardiology.

[28]  G S Weinstein,et al.  Coronary artery surgery study. , 1985, The American journal of cardiology.

[29]  W. Kannel,et al.  Diabetes and cardiovascular disease. The Framingham study. , 1979, JAMA.