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J Thorac Cardiovasc Surg 2006;132:802-810
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

The effect of diabetes mellitus on patients undergoing coronary surgery: A risk-adjusted analysis

Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom.

Received for publication December 2, 2005; revisions received May 10, 2006; accepted for publication May 17, 2006.

^_* Address for reprints: R. Ascione, MD, ChM, FRCS, FETCS, Reader in Cardiac Surgery Sciences, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, BS2 8HW, United Kingdom. (Email: r.ascione{at}bristol.ac.uk).

Background: Surgical case-mix is seriously worsening, and the results of surgical revascularization on high-risk cohorts should be continuously evaluated. This study investigates the influence of diabetes mellitus on the short and midterm outcome in the modern era of coronary surgery.

Methods and Results: Patients who underwent first-time coronary artery bypass grafting from April 1996 to October 2003 were classified into diabetic and nondiabetic groups. Data were prospectively collected and retrospectively analyzed. A total of 5259 patients were studied, and of these 877 (17%) were diabetic. Patients with diabetes were more likely to be female, have a higher body mass index, be in an advanced New York Heart Association class and Canadian Cardiovascular Society class, have a history of congestive heart failure, have a poor ejection fraction, renal failure, and more extensive coronary artery disease than the nondiabetic group (P < .001 for all). In-hospital mortality was 2.2% and 1% for diabetic and nondiabetic patients, respectively; however, diabetes was not found to be an independent risk factor for in-hospital mortality (odds ratio = 1.63; 95% confidence interval 0.92-2.88; P = .089). Postoperative complications were comparable in the two groups, with only renal, neurologic, and gastrointestinal complications significantly associated with diabetes (all P .05). There was no association between diabetes mellitus and postoperative infective complications. Diabetes remained an independent predictor of 5-year mortality (hazard ratio 1.55; 95% confidence interval 1.22-1.96; P < .001) and of lower 5-year cardiac-related event-free survival.

Conclusion: Despite a worsening cohort, diabetic patients could be surgically revascularized with low morbidity and mortality, comparable with control patients. The negative effect of diabetes mellitus on the longer-term mortality and morbidity remains a problem.

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