Advertisement

Effect of Diabetes Mellitus on Complication Rates of Coronary Artery Bypass Grafting

      Previous studies have shown that diabetes mellitus (DM) is a risk factor for postoperative coronary artery bypass grafting (CABG) complications. More contemporary studies are needed to guide revascularization decisions in DM patients. We performed a single-center study of patients who underwent CABG. Patients with no DM were compared with patients with DM, subgrouped according to whether or not DM was treated with insulin before admission (Insulin and No Insulin Groups). Multivariable logistic regression was used to determine whether DM was a significant predictor of mortality, combined postoperative events, and specific postoperative complications after controlling for other predictive clinical variables. Of 11,590 consecutive patients who underwent CABG, 5,013 (43%) had DM and 6,577 (57%) had no DM. Of the patients with DM, 3,433 (68%) were not treated with insulin and 1,580 (32%) were treated with insulin before admission. Multivariable logistic regression analyses showed that DM was not significantly associated with in-hospital mortality or combined postoperative events after considering other clinical variables. The No Insulin Group was significantly associated with stroke, and the Insulin Group was significantly associated with surgical site infection and new renal failure. In conclusion, this study of consecutively treated CABG patients shows that DM is not a predictor of in-hospital mortality or combined in-hospital postoperative events after adjusting for other clinical factors. DM is a predictor of permanent stroke, surgical site infection, and new renal failure. These findings may help with case selection and management of DM patients undergoing CABG.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Benjamin EJ
        • Blaha MJ
        • Chiuve SE
        • Cushman M
        • Das SR
        • Deo R
        • de Ferranti SD
        • Floyd J
        • Fornage M
        • Gillespie C
        • Isasi CR
        • Jimenez MC
        • Jordan LC
        • Judd SE
        • Lackland D
        • Lichtman JH
        • Lisabeth L
        • Liu S
        • Longenecker CT
        • Mackey RH
        • Matsushita K
        • Mozaffarian D
        • Mussolino ME
        • Nasir K
        • Neumar RW
        • Palaniappan L
        • Pandey DK
        • Thiagarajan RR
        • Reeves MJ
        • Ritchey M
        • Rodriguez CJ
        • Roth GA
        • Rosamond WD
        • Sasson C
        • Towfighi A
        • Tsao CW
        • Turner MB
        • Virani SS
        • Voeks JH
        • Willey JZ
        • Wilkins JT
        • Wu JH
        • Alger HM
        • Wong SS
        • Muntner P
        • American Heart Association Statistics C
        • Stroke Statistics S
        Heart disease and stroke statistics-2017 update: a report from the American Heart Association.
        Circulation. 2017; 135: e146-e603
        • Shahian DM
        • O'Brien SM
        • Filardo G
        • Ferraris VA
        • Haan CK
        • Rich JB
        • Normand SL
        • DeLong ER
        • Shewan CM
        • Dokholyan RS
        • Peterson ED
        • Edwards FH
        • Anderson RP
        • Society of Thoracic Surgeons Quality Measurement Task F
        The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1–coronary artery bypass grafting surgery.
        Ann Thorac Surg. 2009; 88: S2-S22
        • Beckman JA
        • Creager MA
        • Libby P
        Diabetes and atherosclerosis: epidemiology, pathophysiology, and management.
        JAMA. 2002; 287: 2570-2581
        • Brancati FL
        • Whelton PK
        • Kuller LH
        • Klag MJ
        Diabetes mellitus, race, and socioeconomic status. A population-based study.
        Ann Epidemiol. 1996; 6: 67-73
        • Thourani VH
        • Weintraub WS
        • Stein B
        • Gebhart SS
        • Craver JM
        • Jones EL
        • Guyton RA
        Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting.
        Ann Thorac Surg. 1999; 67: 1045-1052
        • Carson JL
        • Scholz PM
        • Chen AY
        • Peterson ED
        • Gold J
        • Schneider SH
        Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery.
        J Am Coll Cardiol. 2002; 40: 418-423
        • Filsoufi F
        • Rahmanian PB
        • Castillo JG
        • Mechanick JI
        • Sharma SK
        • Adams DH
        Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting.
        Interact Cardiovasc Thorac Surg. 2007; 6: 753-758
        • Li Z
        • Amsterdam EA
        • Young JN
        • Hoegh H
        • Armstrong EJ
        Contemporary outcomes of coronary artery bypass grafting among patients with insulin-treated and non-insulin-treated diabetes.
        Ann Thorac Surg. 2015; 100: 2262-2269
      1. http://riskcalc.sts.org/stswebriskcalc/#/calculate, Accessed on May 6, 2018.

        • Geiss LS
        • Wang J
        • Cheng YJ
        • Thompson TJ
        • Barker L
        • Li Y
        • Albright AL
        • Gregg EW
        Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012.
        JAMA. 2014; 312: 1218-1226
        • Bypass Angioplasty Revascularization Investigation I
        Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease.
        N Engl J Med. 1996; 335: 217-225
        • Farkouh ME
        • Domanski M
        • Sleeper LA
        • Siami FS
        • Dangas G
        • Mack M
        • Yang M
        • Cohen DJ
        • Rosenberg Y
        • Solomon SD
        • Desai AS
        • Gersh BJ
        • Magnuson EA
        • Lansky A
        • Boineau R
        • Weinberger J
        • Ramanathan K
        • Sousa JE
        • Rankin J
        • Bhargava B
        • Buse J
        • Hueb W
        • Smith CR
        • Muratov V
        • Bansilal S
        • King 3rd, S
        • Bertrand M
        • Fuster V
        • Investigators FT
        Strategies for multivessel revascularization in patients with diabetes.
        N Engl J Med. 2012; 367: 2375-2384
        • Kosiborod M
        • McGuire DK
        Glucose-lowering targets for patients with cardiovascular disease: focus on inpatient management of patients with acute coronary syndromes.
        Circulation. 2010; 122: 2736-2744
        • Sattar N
        • Petrie MC
        • Zinman B
        • Januzzi Jr., JL
        Novel diabetes drugs and the cardiovascular specialist.
        J Am Coll Cardiol. 2017; 69: 2646-2656
        • Ferrannini E
        • DeFronzo RA
        Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes.
        Eur Heart J. 2015; 36: 2288-2296
        • Shahian DM
        • Jacobs JP
        • Edwards FH
        • Brennan JM
        • Dokholyan RS
        • Prager RL
        • Wright CD
        • Peterson ED
        • McDonald DE
        • Grover FL
        The society of thoracic surgeons national database.
        Heart. 2013; 99: 1494-1501
      2. STS Adult Cardiac Surgery Database data collection forms and specifications, https://www.sts.org/sites/default/files/documents/ACSDTrainingManual_V2-9_April2018-3.pdf. Accessed May 1, 2018.

        • van den Berghe G
        • Wouters P
        • Weekers F
        • Verwaest C
        • Bruyninckx F
        • Schetz M
        • Vlasselaers D
        • Ferdinande P
        • Lauwers P
        • Bouillon R
        Intensive insulin therapy in critically ill patients.
        N Engl J Med. 2001; 345: 1359-1367
        • Hillis LD
        • Smith PK
        • Anderson JL
        • Bittl JA
        • Bridges CR
        • Byrne JG
        • Cigarroa JE
        • Disesa VJ
        • Hiratzka LF
        • Hutter Jr., AM
        • Jessen ME
        • Keeley EC
        • Lahey SJ
        • Lange RA
        • London MJ
        • Mack MJ
        • Patel MR
        • Puskas JD
        • Sabik JF
        • Selnes O
        • Shahian DM
        • Trost JC
        • Winniford MD
        • American College of Cardiology F, American Heart Association Task Force on Practice G, American Association for Thoracic S, Society of Cardiovascular A and Society of Thoracic S
        2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2011; 58: e123-e210
        • Stone GW
        Revascularization decisions in coronary artery disease: hitting a moving target.
        JACC Cardiovasc Interv. 2014; 7: 507-509
        • Hlatky MA
        Compelling evidence for coronary-bypass surgery in patients with diabetes.
        N Engl J Med. 2012; 367: 2437-2438
        • Alserius T
        • Anderson RE
        • Hammar N
        • Nordqvist T
        • Ivert T
        Elevated glycosylated haemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery.
        Scand Cardiovasc J. 2008; 42: 392-398
        • Halkos ME
        • Puskas JD
        • Lattouf OM
        • Kilgo P
        • Kerendi F
        • Song HK
        • Guyton RA
        • Thourani VH
        Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery.
        J Thorac Cardiovasc Surg. 2008; 136: 631-640