Feautures of perioperative period of high-risk patients with coronary artery disease and type 2 Diabetes Mellitus.

Abstract

The aim –to analyze perioperative period for patients with CAD and Diabetes mellitus (DM). Materials and methodsRetrospective analysis of 354 high-risk patients who were operated on and discharged from our Institute in the period from 2009 to 2019. All patients underwent ECG, ECHO, coronary angiography and CABG with correction of concomitant cardiac pathology. Results90 (25.4 %) patients had type 2 DM, 161 (45.45 %) – impaired glucose tolerance (IGT). Among patients with DM, 43 (47.7%) had I-III degree obesity (p = 0.017) and 17 (18.8%) - gout (p = 0.0008). In patients with normal glucose metabolism, the comorbidity index was significantly lower than in DM (4.88 ± 1.38, vs. 6.6 ± 2.03, p < 0.0001) and IGT 5.8 ± 1.5 (p <0.0001). Patients with DM were more severe on ES II scale - ES II 9.5 ± 6.6% vs. 8.09 ± 5.8% (p = 0.115). The number of grafts in patients with DM averaged 3.2 ± 1.19 vs. 2.9 ± 1.3 in normoglycemia (p = 0.097). Calcified coronary arteries were detected in patients with normoglycemia in 6 (5.8%) cases, in IGT - in 10 (6.2%), and in DM - in 11 (12.2%). In the postoperative period, AF occurred in 83 (23.4 %) patients, of whom 70 (84.3 %) had type 2 DM and IGT. Deep sternal infection occurred in 4 (4.4 %) patients with type 2 DM. Stroke and TIA had 10 (2.8 %) patients among which 9 (90 %) had glucose metabolism disturbance. Acute kidney injury occurred in 10 (2.8 %) patients, of whom 8 (80 %) had type 2 DM and IGT. ConclusionsPatients with DM were more severe and had more complications. Timely compensation of comorbidity helps to avoid negative results.