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J Thorac Cardiovasc Surg 2003;125:144-154
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease

From the Department of Cardiology and Cardiac Surgery, University "G. D'Annunzio," Chieti, Italy.

Received for publication Aug 2, 2001. Revisions requested Oct 1, 2001; revisions received May 7, 2002. Accepted for publication May 16, 2002. Address for reprints: Antonio Maria Calafiore, MD, "G. D'Annunzio" University Division of Cardiac Surgery c/o S. Camillo de' Lellis Hospital via C. Forlanini, 50, 66100 Chieti, Italy (E-mail: calafiore{at}unich.it).

Objective: Diabetes has not yet been investigated as a risk factor for early and late cardiac-related death.
Methods: Patients operated on from January 1988 to December 1999 were considered; 767 were diabetic (group D) and 2593 were nondiabetic (group ND). Patients with preoperative hemodynamic deterioration were excluded. Early (30-day) mortality (any causes and cardiac causes) was evaluated with univariate analysis and stepwise logistic regression. Ten-year actuarial freedom from death of any cause and cardiac death was also assessed with univariate and Cox analyses.
Results: Early mortality was 2.2% (group D, 3.3%; group ND, 1.9%; P = .023). Early cardiac mortality was 1.3% (group D, 2.2%; group ND, 1.1%; P = .0016). Diabetes was an independent risk factor only for cardiac death and not for death of any cause. Five-year survival was 93.5% ± 0.5% (group D, 92.5% ± 1.1%; group ND, 93.9% ± 0.6%; P = .0304). Diabetes was not an independent risk factor. Five-year freedom for cardiac death was 96.3% ± 0.4% (group D, 94.9% ± 0.9%; group ND, 96.6% ± 0.4%; P = .0155). Diabetes was an independent risk factor. However, if only the patients who survived the first 30 days are considered, diabetes disappears as a risk factor (5-year freedom for cardiac death, 97.8% ± 0.3%; group D, 97.3% ± 0.8%; group ND, 97.9% ± 0.4%; P = 0.2389).
Conclusions: Diabetes is an independent risk factor for early cardiac death only. Long-term survival in patients who survive the first 30 days is not statistically significantly different for diabetic and nondiabetic patients. In fact, the rates appear very similar.

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