Diabetes mellitus and its impact on long-term outcomes after coronary artery bypass graft surgery

• Published in: Acta diabetologica Vol. 50; no. 2; pp. 123 - 128
• Main Authors: Wit, M. A. M., de Mulder, M., Jansen, E. K., Umans, V. A. W. M.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.04.2013; Springer Nature B.V
• Subjects: Aged; Atherosclerosis - complications; Atherosclerosis - surgery; Coronary Angiography; Coronary Artery Bypass - mortality; Diabetes; Diabetes Complications - epidemiology; Diabetes Complications - mortality; Diabetes Complications - surgery; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Female; Heart surgery; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Internal Medicine; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Mortality; Myocardial Infarction - epidemiology; Original Article; Prospective Studies; Surgical outcomes; Treatment Outcome; Diabetes mellitus; Mortality; Bypass graft dysfunction; Coronary artery bypass graft surgery
• ISSN: 0940-5429; 1432-5233
• DOI: 10.1007/s00592-010-0223-3

Diabetes mellitus (DM) is an important risk factor for accelerated atherosclerosis and increases cardiovascular disease. Several studies found a higher mortality rate in postoperative diabetic patients than in non-diabetic patients. However, other studies found conflicting evidence on bypass graft dysfunction in patients with diabetes mellitus. We therefore investigated the influence of diabetes mellitus on the long-term outcome after coronary artery bypass surgery (CABG). In this prospective study, 936 consecutive CABG patients were included. These patients were divided into three groups: patients without diabetes mellitus, patients with diabetes mellitus using oral drugs (non-insulin-treated DM) and patients with diabetes mellitus using insulin (insulin-treated DM). The three groups were compared for mortality and (angiographic) bypass graft dysfunction. Of the 936 included patients, 720 (76.8%) patients were non-diabetics, 138 (14.7%) were non-insulin-treated DM, and 78 (8.3%) patients were insulin-treated DM. Follow-up was achieved in all patients, at a mean of 33 months. Mortality was significantly higher in patients with insulin-treated DM, compared with non-insulin-treated DM or non-diabetic patients ( P  = 0.003). Fourteen (1.5%) patients suffered a myocardial infarction after CABG. A coronary angiography was performed in 77 (8.2%) patients during follow-up, proven bypass graft dysfunction was found in 41 (53.2%) patients. There was no significant difference in bypass graft dysfunction between the three groups. Diabetes mellitus has a significant impact on long-term follow-up after coronary surgery. Particularly insulin dependency is related to an increased mortality. However, diabetes has no influence on angiographically proven bypass graft dysfunction.