Factors associated with in-hospital mortality after coronary artery bypass grafting in patients with CHD and type 2 diabetes
Abstract
Coronary artery bypass grafting (CABG) is the main method used for myocardial revascularisation in patients with diabetes mellitus (DM), and determining the factors affecting the outcomes of CABG in these patients is important.
Objective.
To identify risk factors for in-hospital mortality after coronary artery surgery (CABG) for patients with and without type 2 diabetes mellitus (T2DM).
Methods.
A retrospective analysis of the medical records of patients who underwent CABG from 2006 to 2009 was conducted. From these, 317 patients with T2DM were selected (median age: 59,0 years). As a control group, 350 patients (median age: 58,0 years) without diabetes or pre-diabetes, who were matched by sex, age and CABG characteristics, were selected. Logistic regression models were used to identify factors possibly associated with in-hospital mortality.
Results.
There were no group differences for the frequency of postoperative complications and in-hospital mortality (p >0,05). During the early postoperative period, 5 (1,6%) diabetic and 7 (2,0%) non-diabetic patients died (p=0,682). By the logistic regression analysis, T2DM did not predict patient mortality (p=0,458). Among the patients with T2DM, a risk of death was associated with a stroke history (OR 21,661; 95% CI 1,701-76,521; р=0,013), and a decreased glomerular filtration rate (GFR) as estimated by the CKD-EPI equation (OR 1,512 per 5 ml/min/1,73m2.
decrease; 95% CI 1,017-2,257; р=0,048), independent of gender, age or triple-vessel and left-main disease. By multivariate analysis for the non-diabetic patients, the risk of death increased by more than 10 times because of reinfarction (OR=10,272; 95% CI: 1,258?56,163; p=0,029) and increased by 6,8 times with an increase in preoperative fibrinogen levels of 1 g/l (OR=6,802; 95% CI: 1,283?35,714; p=0,024), independent of gender, age, smoking or mitral valve regurgitation.
Conclusions.
T2DM was not a predictor of death during the early period after CABG. For the diabetic patients, independent predictors of in-hospital mortality after CABG were stroke history and reduced GFR. For the patients without T2DM, the independent predictors were reinfarction and preoperative fibrinogen levels.
Objective.
To identify risk factors for in-hospital mortality after coronary artery surgery (CABG) for patients with and without type 2 diabetes mellitus (T2DM).
Methods.
A retrospective analysis of the medical records of patients who underwent CABG from 2006 to 2009 was conducted. From these, 317 patients with T2DM were selected (median age: 59,0 years). As a control group, 350 patients (median age: 58,0 years) without diabetes or pre-diabetes, who were matched by sex, age and CABG characteristics, were selected. Logistic regression models were used to identify factors possibly associated with in-hospital mortality.
Results.
There were no group differences for the frequency of postoperative complications and in-hospital mortality (p >0,05). During the early postoperative period, 5 (1,6%) diabetic and 7 (2,0%) non-diabetic patients died (p=0,682). By the logistic regression analysis, T2DM did not predict patient mortality (p=0,458). Among the patients with T2DM, a risk of death was associated with a stroke history (OR 21,661; 95% CI 1,701-76,521; р=0,013), and a decreased glomerular filtration rate (GFR) as estimated by the CKD-EPI equation (OR 1,512 per 5 ml/min/1,73m2.
decrease; 95% CI 1,017-2,257; р=0,048), independent of gender, age or triple-vessel and left-main disease. By multivariate analysis for the non-diabetic patients, the risk of death increased by more than 10 times because of reinfarction (OR=10,272; 95% CI: 1,258?56,163; p=0,029) and increased by 6,8 times with an increase in preoperative fibrinogen levels of 1 g/l (OR=6,802; 95% CI: 1,283?35,714; p=0,024), independent of gender, age, smoking or mitral valve regurgitation.
Conclusions.
T2DM was not a predictor of death during the early period after CABG. For the diabetic patients, independent predictors of in-hospital mortality after CABG were stroke history and reduced GFR. For the patients without T2DM, the independent predictors were reinfarction and preoperative fibrinogen levels.
About the Authors
Aleksey Nikolaevich Sumin
Research Institute of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
MD, PhD, Head of Department of Multifocal Atherosclerosis
Natalya Alexandrovna Bezdenezhnykh
Research Institute of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
MD, research associate, Laboratory of Сirculation Pathology, Department of Multifocal Atherosclerosis
Andrey Viktorovich Bezdenezhnykh
Research Institute of Cardiovascular Diseases, Kemerovo
Russian Federation
senior research associate, Laboratory of Сirculation Pathology, Department of Multifocal Atherosclerosis
Russian Federation
senior research associate, Laboratory of Сirculation Pathology, Department of Multifocal Atherosclerosis
Sergey Vasil'evich Ivanov
Research Institute of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
MD, PhD, Head of Laboratory of Reconstructive Surgery, Department of Multifocal Atherosclerosis
Ekaterina Vladimirovna Belik
Research Institute of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
MD, junior research associate, Laboratory of Homeostatis, Deparment of Diagnostics
Olga Leonidovna Barbarash
Research Institute of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
MD, PhD, Professor, Head of Research Institute of Cardiovascular Diseases
References
1. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035-3087. doi: 10.1093/eurheartj/eht108.
2. Дедов ИИ, Терёхин СА. Реваскуляризация миокарда у больных сахарным диабетом. Сахарный диабет. 2010; (4):18-23. [Dedov II, Terekhin SA. Myocardial revascularization in diabetic patients. Diabetes mellitus. 2010;(4):18-23.] doi: 10.14341/2072-0351-6052
3. Pivatto Júnior F, Pereira EMC, Valle FH, Teixeira Filho GF, Nesralla IA, Sant'anna JRM, et al. Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery. Revista Brasileira de Cirurgia Cardiovascular 2012;27(4):600-606. Available from: http://www.gnresearch.org/doi/10.5935/1678-9741.20120102 PubMed PMID: 23515733. doi: 10.5935/1678-9741.20120102.
4. Tennyson C, Lee R, Attia R. Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery. Interactive CardioVascular and Thoracic Surgery 2013;17(6):1000-1008. Available from: http://icvts.oxfordjournals.org/cgi/doi/10.1093/icvts/ivt351 doi: 10.1093/icvts/ivt351.
5. Lee BJ, Herbison P, Wong C. Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement? J Geriatr Cardiol 2014;11(1):83-89. Available from: http://europepmc.org/abstract/MED/24748887 PubMed PMID: 24748887. doi: 10.3969/j.issn.1671-5411.2014.01.009.
6. Bangalore S, Toklu B, Feit F. Outcomes With Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention for Patients With Diabetes Mellitus: Can Newer Generation Drug-Eluting Stents Bridge the Gap? Circ Cardiovasc Interv 2014;7(4):518-525. PubMed PMID: 24939927. doi: 10.1161/CIRCINTERVENTIONS.114.001346.
7. 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. Interact Cardiovasc Thorac Surg 2007;6(6):753-758. doi: 10.1510/icvts.2007.158709.
8. Petursson P, Herlitz J, Lindqvist J, Sjöland H, Gudbjörnsdottir S. Prevalence and severity of abnormal glucose regulation and its relation to long-term prognosis after coronary artery bypass grafting. Coron Artery Dis 2013;24(7):577-582. Available from: http://www.nlm.nih.gov/medlineplus/aftersurgery.html PubMed PMID: 23903350. doi: 10.1097/MCA.0b013e3283645c94.
9. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for Multivessel Revascularization in Patients with Diabetes. N Engl J Med 2012;367(25):2375-2384. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa1211585 PubMed PMID: 23121323. doi: 10.1056/NEJMoa1211585.
10. Hakeem A, Garg N, Bhatti S, Rajpurohit N, Ahmed Z, Uretsky BF. Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data. J Am Heart Assoc 2013;2(4):354. Available from: http://jaha.ahajournals.org/cgi/pmidlookup?view=long&pmid=23926119 PubMed PMID: 23926119. doi: 10.1161/JAHA.113.000354.
11. Strahan S, Harvey RM, Campbell-Lloyd A, Beller E, Mundy J, Shah P. Diabetic control and coronary artery bypass: effect on short-term outcomes. Asian Cardiovascular and Thoracic Annals 2013;21(3):281-287. Available from: http://aan.sagepub.com/lookup/doi/10.1177/0218492312451983 PubMed PMID: 24570493. doi: 10.1177/0218492312451983.
12. Gumus F, Polat A, Sinikoglu SN, Yektas A, Erkalp K, Alagol A. Use of a Lower Cut-Off Value for HbA1c to Predict Postoperative Renal Complication Risk in Patients Undergoing Coronary Artery Bypass Grafting. Journal of Cardiothoracic and Vascular Anesthesia 2013;27(6):1167-1173. Available from: http://linkinghub.elsevier.com/retrieve/pii/S105307701300133X PubMed PMID: 24008164. doi: 10.1053/j.jvca.2013.02.030.
13. Subramaniam B, Lerner A, Novack V, Khabbaz K, Paryente-Wiesmann M, Hess P, et al. Increased glycemic variability in patients with elevated preoperative HbA1C predicts adverse outcomes following coronary artery bypass grafting surgery. Anesth Analg 2014;118(2):277-287. Available from: http://www.nlm.nih.gov/medlineplus/bloodsugar.html PubMed PMID: 24445629. doi: 10.1213/ANE.0000000000000100.
14. American Diabetes Association . Standards of medical care in diabetes-2011. Diabetes Care 2011;34(1):11-61. doi: 10.2337/dc11-S011.
15. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под редакцией И.И. Дедова, М.В. Шестаковой (6-й выпуск). Сахарный диабет. 2013;(1s):1-121. [Dedov I, Shestakova M, Aleksandrov A, Galstyan G, Grigoryan O, Esayan R, et al. Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV (6th edition). Diabetes mellitus. 2013;(1S):1-120.] doi: 10.14341/DM20131S1-121
16. Шафранская КС, Зыков МВ, Быкова ИС, Калаева ВВ, Евсеева МВ, Иванов СВ, и соав. Связь почечной дисфункции с госпитальными осложнениями у пациентов с ишемической болезнью сердца, подвергшихся коронарному шунтированию. Креативная кардиология.2013; (2): 5-14. [Shafranskaja KS, Zykov MV, Bykova IS, Kalaeva VV, Evseeva MV, Ivanov SV, Kashtalap VV, Karetnikova VN, Barbarash OL. Communication with renal dysfunction hospital complications in patients with coronary artery disease undergoing coronary artery bypass grafting. Creative cardiology. 2013; (2): 5-14.]
17. Koochemeshki V, Salmanzadeh HR, Sayyadi H, Amestejani M, Salehi Ardabili S . The effect of diabetes mellitus on short term mortality and morbidity after isolated coronary artery bypass grafting surgery. Int Cardiovasc Res J 2013;7(2):41-45. PubMed PMID:3987431.
18. Gallagher S, Kapur A, Lovell MJ, Jones DA, Kirkwood A, Hassan S, et al. Impact of diabetes mellitus and renal insufficiency on 5-year mortality following coronary artery bypass graft surgery: a cohort study of 4869 UK patients. Eur J Cardiothorac Surg 2014;45(6):1075-1081. PubMed PMID: 24448075. doi: 10.1093/ejcts/ezt630.
19. Beohar N, Sansing VV, Davis AM, Srinivas VS, Helmy T, Althouse AD, et al. Race/ethnic disparities in risk factor control and survival in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial. Am J Cardiol 2013;112(9):1298-1305. Available from: http://ClinicalTrials.gov/search/term=23910429%20%5BPUBMED-IDS%5D PubMed PMID: 23910429. doi: 10.1016/j.amjcard.2013.05.071.
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Sumin A.N., Bezdenezhnykh N.A., Bezdenezhnykh A.V., Ivanov S.V., Belik E.V., Barbarash O.L. Factors associated with in-hospital mortality after coronary artery bypass grafting in patients with CHD and type 2 diabetes. Diabetes mellitus. 2014;17(4):25-34. (In Russ.)
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