Abstract
To investigate the risk factors for in-hospital death in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). We conducted a retrospective study with 305 consecutive diabetic patients undergoing CABG in the Division of Cardiovascular Surgery of our institution from April 2004 to April 2010. Univariate analysis for categorical variables was performed with the chi-square or Fisher's exact test, as appropriate. Potential risk factors with p <0.05 in the univariate analysis were included in the multivariate analysis, which was performed by backward logistic regression. Values of p <0.05 were considered statistically significant. The study population had a mean age of 61.44 years (± 9.81) and 65.6% (n=200) were male. The in-hospital mortality rate was 11.8% (n=36). The following independent risk factors for death were identified: on-pump CABG (OR 6.15, 95% CI 1.57 to 24.03, P=0.009) and low cardiac output in the postoperative period (OR 34.17, 95% CI 10.46 to 111.62, P <0.001). The use of internal thoracic artery (ITA) was an independent protective factor for death (OR 0.27, 95% CI 0.08 to 0.093, P=0.038). This study identified the following independent risk factors for death after CABG: on-pump CABG and low cardiac output syndrome. The use of ITA was an independent protective factor.
Highlights
The prevalence of diabetes mellitus (DM) throughout the western world has been increasing at an alarming rate in recent years[1]
Diabetic patients have a worse prognosis when compared to non-diabetics in relation to coronary heart disease and display different evolutions when treated by percutaneous intervention with catheter or by surgery[3]
The study population was identified among 849 coronary artery bypass surgeries, showing a prevalence of 35.9% (n = 305) of diabetes among patients undergoing this type of surgical procedure in our local institution
Summary
The prevalence of diabetes mellitus (DM) throughout the western world has been increasing at an alarming rate in recent years[1]. Studies show that the presence of DM is an independent risk factor for postoperative mortality of coronary artery bypass grafting (CABG), with an odds ratio of 1.73 for death from cardiovascular causes[4] and 2.94 for overall mortality[5]. Medical evidence leads to a greater tendency of indicating CABG in diabetics with multivessel disease[2]. In such patients CABG should always be considered in view of the benefits in the medium and long term when compared to medical and interventional treatments. When indicating surgery in the presence of DM, one should consider the potential increased surgical risk and special care in pre-operative and postoperative handling[2]
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