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Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Cardiothoracic Surgery, University Hospital, Coimbra, Portugal

Received 28 January 2008; received in revised form 5 May 2008; accepted 9 May 2008.

^_* Corresponding author. Address: Cirurgia Cardiotorácica, Hospitais da Universidade, 3000-075 Coimbra, Portugal. Tel.: +351 239400418; fax: +351 239829674. (Email: antunes.cct.huc{at}sapo.pt).

Objectives: We aimed at determining the effect of diabetes mellitus (diabetes) on short-term mortality and morbidity in a cohort of patients with ischemic disease undergoing coronary artery bypass surgery (CABG) at our institution. Material and methods: A total of 4567 patients undergoing isolated CABG in a 10-year period were studied. Diabetes mellitus was present in 22.6% of the cases but the percentage increased from 19.1% in the beginning to 27% in the end of the study period (p < 0.0001 for the decade time-trend). Compared with non-diabetic patients, the group with diabetes was older (61.5 ± 8.4 years vs 60.4 ± 9.5 years), had a higher body mass index (26.4 ± 2.2 vs 26.0 ± 2.2), comprised more women (17.5% vs 10.1%), and had a greater incidence of peripheral vascular disease (13.3% vs 8.8%), cerebrovascular disease (8.3% vs 4.3%), renal failure (2.7% vs 1.1%), cardiomegaly (14.0% vs 10.9%), class III–IV angina (43.4% vs 39.0%), triple-vessel disease (80.9% vs 73.7%) and patients with left ventricular dysfunction (all p < 0.05). Demographic and peri-procedural data were registered prospectively in a computerized institutional database. Multivariate logistic regression was performed to assess the influence of diabetes as an independent risk factor for in-hospital mortality and morbidity. Results: The overall in-hospital mortality was 0.96% [n = 44; diabetics: 1.0%, non-diabetics: 0.9% (p = 0.74)]. The mortality of patients with diabetes decreased from 2.7% in the early period to 0.7% in the late period (p = 0.03 for the time-trend). Postoperative in-hospital complications were comparable in the two groups in univariate analysis, with only cerebrovascular accident and prolonged length of stay being significantly higher in the diabetic patients (all p < 0.05). In multivariate analysis, diabetes was not found to be an independent risk factor for in-hospital mortality (OR = 0.61; 95% CI = 0.28–1.30; p = 0.19), but predicted the occurrence of mediastinitis (OR = 1.80; 95% CI = 1.01–3.22; p = 0.049). Conclusions: Despite worse demographic and clinical characteristics, diabetic patients could be surgically revascularized with low mortality and morbidity, comparable with control patients. Hence, our data do not support diabetes as a risk factor for significantly adverse early outcome following CABG.

Key Words: Coronary artery bypass grafting (CABG) • Diabetes mellitus • Risk factors • Early outcome