Coronary Artery Disease
Comparison of Factors Associated With 30-Day Mortality After Coronary Artery Bypass Grafting in Patients With Versus Without Diabetes Mellitus

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Abstract

The purpose of this study was to identify factors associated with 30-day mortality after coronary artery bypass graft surgery (CABG) among diabetic patients, and to compare them with risk factors among nondiabetics. A subanalysis of a prospective national cohort study was performed which included patients who underwent CABG in 14 medical centers in Israel during 1994. Data including patient demographic and historical information, comorbidity, and cardiac catheterization results were collected by trained nurses. Data were derived from direct patient interviews, charts, catheterization reports, surgical reports, and national vital records. Multivariate logistic regression analysis was used to identify factors associated with a 30-day mortality in diabetic and nondiabetic patient populations. The results showed that crude mortality was 5.0% among diabetic patients (n = 1,034) and 2.5% among nondiabetics (n = 3,350; p <0.001). The risk profile in diabetics was found to be worse. Multivariate logistic regression analysis identified female gender, 3-vessel disease, and left main disease as independent risk factors for 30-day, post-CABG mortality unique to diabetic patients. Left ventricular dysfunction was found to effect a greater risk among diabetic patients, whereas chronic renal failure was associated with greater risk among nondiabetics. In conclusion, we found differences in patterns of risk factors for post-CABG mortality between diabetics and nondiabetics. These findings may help physicians to identify patients at high risk for CABG mortality.

Section snippets

Methods

This study is predicated on a database collected in a national Israeli outcome study of CABG. The investigation included most patients who underwent isolated CABG in each of the 14 centers that performed open-heart operations in Israel during 1994. The choice of candidate-predictive variables for early mortality was based on a review of published reports and on the definitions of a panel of clinical experts. Cardiac catheterizations were performed at the participating or referring institutions

Results

The study comprised 1,034 diabetic patients receiving either oral hypoglycemics or insulin, and 3,350 patients with no history of diabetes. Because of incomplete data, 291 patients were excluded.

Crude, unadjusted 30-day mortality was 5.0% in diabetics and 2.5% in nondiabetics (p <0.001). Crude mortality rates by gender in nondiabetics were 2.3% for men and 3.5% for women (p = NS); among diabetic patients, crude mortality rates by gender were 3.7% for men and 8.3% for women (p = 0.002).

Diabetics

Discussion

The main result of this study was that female gender was found to be an independent risk factor for 30-day mortality among diabetic patients undergoing CABG, but not among nondiabetic patients. This finding, by way of multivariate analysis controlling for possible confounders, supports the observation made by Carey et al[5] in a univariate analysis; among 1,335 patients who underwent CABG they found excess crude in-hospital mortality among female diabetic patients (11% vs 3.6% for male

Acknowledgements

Acknowledgment:

We thank Haya R. Rubin, MD, for her thoughtful comments and help in editing this manuscript.

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    Decreased contractility and increased arrhythmogenicity is seen in the diabetic cardiac muscle [39–41]. Some authors have demonstrated that patients with diabetes mellitus who undergo coronary artery bypass grafting have increased perioperative mortality and morbidity, significantly reduced long-term survival, and less freedom from recurrent episodes of angina [42–44]. Fortunately, evidence suggests that achieving tighter glucose control (125 to 200 mg/dL) in diabetic patients during acute coronary syndromes improves survival [41].

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The Israeli study of outcomes after coronary artery bypass grafting 1994: Azay Appelbaum; Nima Amit; Yitzhak Berlovitz; Dani Biteran; Amram J. Cohen; Elieser Kaplinsky; Jacob Lavee; Gideon Merin; Simcha Milo; Gideon Uretzky; Gideon Sahar; Arie Schachner; Aram K. Smolensky; Bernardo Vidne; Vladimir Yakirevitch.

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