Abstract
Objective: To study insulin resistance markers and their relationship with preoperative status and hospital complications of coronary artery bypass grafting (CABG) in patients with type 2 diabetes, prediabetes and normoglycemia. Methods: We included 383 consecutive patients who underwent CABG. Patients were divided into two groups—with carbohydrate metabolism disorders (CMD, n = 192) and without CMD (n = 191). Free fatty acids and fasting insulin in plasma were determined, and the Disse, QUICKI and revised QUICKI indices were calculated in all patients. Perioperative characteristics and postoperative complications were analyzed in these groups, and their relations with markers of insulin resistance. Results: Screening before CABG increased the number of patients with CMD from 25.3% to 50.1%. Incidence of postoperative stroke (p = 0.044), and hospital stay after CABG > 30 days (p = 0.014) was greater in CMD patients. Logistic regression analysis revealed that an increase in left atrial size, age, aortic clamping time, and decrease in Disse index were independently associated with hospital stay >10 days and/or perioperative complications. Conclusions: Screening for CMD before CABG increased the patient number with prediabetes and type 2 diabetes. In the CMD group, there were more frequent hospital complications. The Disse index was an independent predictor of long hospital stay and/or poor outcomes.
Highlights
ConclusionsScreening for carbohydrate metabolism disorders (CMD) before coronary artery bypass grafting (CABG) increased the patient number with prediabetes and type 2 diabetes
The high prevalence of diabetes mellitus (DM) is a recent worldwide trend [1]
Attention is drawn to studying insulin resistance, which can contribute to changes in the function of blood vessels and the heart even with normoglycemia [17], and, potentially, can affect the outcomes of coronary bypass grafting, leveling the effect of carbohydrate metabolism disorders on them
Summary
Screening for CMD prior to coronary artery bypass grafting can significantly increase the number of patients with diagnosed disorders of carbohydrate metabolism (prediabetes and type 2 diabetes). Significant in-hospital CABG complications are more prevalent in the group with CMD. The Disse Insulin Resistance Index is an independent predictor of the combined endpoint (long hospital stay or perioperative complications)
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