Abstract
Background: Previous trials showed that diabetic patients had worse in-hospital and long term outcome after coronary artery bypass grafting (CABG) than non diabetic ones. However, the majority of such studies was carried out in western countries and limited information is available for the Asian population.
 Objective: The present study was intended to determine the impact of diabetes on early and mid-term outcome among patients undergoing CABG surgery in a tertiary care hospital in Bangladesh.
 Methods: This study was performed at Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh, from January to June 2014. Based on enrollment criteria, 202 patients (115 diabeticsand 87 non-diabetics) were enrolled and evaluated for their early outcome (within 30 days of operation) and midterm (after 30 days post-operatively). Patients with known diabetes or preoperative fasting blood sugar ≥6.4 mmol/L or random blood sugar ≥11.1 mmol/L were considered as diabetics. The outcome measures were ICU stay, reopening for bleeding, atrial fibrilation, cardiac arrest, total hospital stay, left ventricular ejection fraction and mortality.
 Results: Diabetic patients in this study had higher prevalence of hypertension, hyperlipidaemia, and renal failure. The diabetic and the non diabetic groups received a mean number of grafts of 3.2±1.06 and 2.81±1.21, respectively, Postoperative mortality in diabetic and non-diabetic patients at early and mid-term were not significantly different in univariate analysis (4.3% vs. 2.3%, p= 0.352) and (2.6 % vs. 2.3%,p = 0.630) respectively. The mean intensive care unit (ICU) stay in diabetic and non-diabetic were same (3.5days) but total hospital stay was significantly higher in the former group (one day or more). Re-opening for bleeding, atrial fibrilation and cardiac arrest in ICU were found higher in DM than those in non-DM group (28.7%vs.20.7%,10.4% vs. 8% and 4.2% vs.1.1% respectively).
 Conclusion: Although the mortality rate of diabetic patients following CABG surgery was in significantly higher than their non-diabetic counterparts. Morbidity was also a bit higher. Strict perioperative glyacemic control could reduce morbidity and mortality in diabetic patients undergoing CABG.
Highlights
Diabetes mellitus (DM) is a well-known risk factor for coronary artery disease and cardiovascular death.[1]
The postoperative outcome data were collected on early mortality, mid-term mortality,stroke [(defined as a central neurologic deficit persisting more than 72 hours], transient ischemic attack (TIA), coma, postoperative renal failure
The intensive care unit (ICU) stays in diabetic and non-diabetics were almost identical (p = 0.338), but total hospital stay was significantly higher in the former group than that in the latter group
Summary
Diabetes mellitus (DM) is a well-known risk factor for coronary artery disease and cardiovascular death.[1]. There are conflicting data about the early and midterm results of CABG in diabetic patients and remains a subject of debate, while some studies reported a significant negative impact of DM, others have suggested a better outcome.[4,7,15,16,18,19,20,21] the majority of such study were carried out in western countries and limited information is available for the Asian population.[3,9,11,15] There is paucity of data about the Bangladeshi people. The majority of such studies was carried out in western countries and limited information is available for the Asian population
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