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The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 264-271, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NW Salomon, US Page, JE Okies, J Stephens, AH Krause and JC Bigelow
A consecutive series of 3,707 patients over a 12 year period undergoing
isolated coronary artery bypass grafting (CABG) included 250 diet/oral
medication-controlled and 162 insulin-dependent patients with diabetes
mellitus. Analysis of 20 pre- and 18 intra-operative variables revealed a
higher incidence of hypertension, left ventricular hypertrophy, and tobacco
consumption for both diabetic groups. The extent of diffuse coronary
disease as judged angiographically and at operation was significantly
greater in both diabetic groups than in nondiabetic CABG patients. No
difference was noted in the incidence of localized coronary disease between
the groups. Average number of grafts was greater in both diabetic groups.
The perioperative mortality was greater for both diabetic groups (5.1% for
non-insulin-dependent diabetes, 4.5% for insulin-dependent diabetes) than
for nondiabetic CABG patients (2.5%). The incidences of sternotomy
complications and renal insufficiency were equal in the diabetic groups and
both were significantly greater than in the nondiabetic group. The number
of total hospital days was also greater in both diabetic groups.
Actuarially determined survival and cardiac event-free curves revealed no
difference between the diabetic groups but a significant difference between
both diabetic groups as compared to the nondiabetic patient population,
with follow-up extending to 10 years after CABG. Results indicate that
diabetic patients have quantitatively and qualitatively more coronary
artery disease than nondiabetic patients and have higher perioperative
morbidity and mortality and a lower long-term survival rate than
nondiabetic patients. However, results continue to justify selection of
patients for CABG based on clinical and anatomic criteria regardless of
diabetic status. Diabetes mellitus should be considered a patient-related
risk factor, both short- and long-term, following CABG.
ARTICLES
Diabetes mellitus and coronary artery bypass. Short-term risk and long- term prognosis
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