posted 01/22/03
Diabetic patients who undergo coronary artery
bypass grafting (CABG) had a 30-day mortality rate similar to that of
non-diabetic patients, but midterm mortality and morbidity were significantly
greater, according to researchers in Sweden.
"An increasing proportion of patients undergoing
coronary artery bypass grafting are diabetics," commented Zoltan Szabo and
colleagues at Linkoping Heart Center.
Szabo and associates determined patient
characteristics and early and midterm mortality and morbidity in 2779 subjects
(539 diabetic, 2240 nondiabetic) who underwent CABG in 1995 to 1999.
The investigators found that the diabetic CABG
patients were younger, more likely to be female, and had a higher incidence of
high blood pressure, triple-vessel involvement, and unstable angina. Bypass and
cross-clamp times were longer for diabetic than for non-diabetic patients, and
the diabetic patients required a greater number of bypasses.
Blood transfusions, dialysis, and the use of
inotropic drugs were more common in the diabetic than in the non-diabetic
patients, and ICU and hospital stays were longer (Early postoperative outcome
and medium-term survival in 540 diabetic and 2,239 non-diabetic patients
undergoing coronary artery bypass grafting. Annals of Thoracic Surgery,
2002;74(3):712-719).
Stroke occurred in 4.3% of the diabetic patients
compared with 1.7% of the non-diabetic patients. Other complications, such as
kidney failure, infections, and mediastinitis, also occurred more frequently in
the diabetic patients than in the non-diabetic patients.
The 30-day mortality for the diabetic patients
(2.6%) was not significantly different than that for the non-diabetic patients
(1.6%), but the cumulative 5-year survival rate was significantly lower (84.4%
vs. 91.3%, respectively; 0<0.001).
"Short-term mortality was acceptable in diabetic
patients after CABG, but they had increased postoperative morbidity in
comparison with non-diabetic patients, particularly with regard to renal
function, cerebral complications, and infections," concluded Szabo and
collaborators. "Midterm survival was impaired in diabetic patients mainly
because of a less favorable outcome in patients treated with insulin."
Key points reported in this study include:
* After coronary artery bypass grafting, diabetic
patients had a 30-day mortality rate similar to that for nondiabetic patients
but had a significantly lower 5-year survival rate
* Among patients who underwent CABG, diabetic
patients had higher rates of complications such as stroke, kidney failure,
mediastinitis, and wound infections
* Among patients who underwent CABG, diabetic patients were more likely than nondiabetic patients to require inotropic drugs, blood transfusions, and dialysis.
Source: Diabetes In Control Dot Com: This article
was prepared by Diabetes Week editors from staff and other reports.
January 2003 News Article Index
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