Chest
Volume 126, Issue 6, December 2004, Pages 1789-1795
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Clinical Investigations
SURGERY
The Influence of Type 2 Diabetes Mellitus in Patients Undergoing Coronary Artery Bypass Graft Surgery: An 8-Year Prospective Cohort Study

https://doi.org/10.1378/chest.126.6.1789Get rights and content

Objective:

To prospectively assess whether there are any outcome differences between patients with and without type 2 diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery.

Study design:

This was an 8-year, prospective hospitalization cohort study. Data were collected on 225 variables concurrently with hospital admission. The main outcome was total operative mortality. In addition, we evaluated 12 morbidity outcomes. To minimize confounding, we controlled for 16 other variables.

Results:

A total of 6,711 patients were available for our analysis (diabetic patients, 2,178; and nondiabetic patients, 4,533). The diabetic patients were significantly more likely to be women, to have more left ventricular hypertrophy, to have a history of cerebrovascular disease, hypertension, and COPD, to have a greater body surface area, to have higher creatinine levels, to be African-American, to have undergone more elective procedures, to have a shorter pump time, and to have less of a history of tobacco use compared to nondiabetic patients (p < 0.05). Multiple regression analysis found no significant difference between the two groups for all 12 morbidity outcomes of interest. Diabetic patients experienced significantly more mortality than nondiabetic patients (relative risk, 1.67; 95% confidence interval, 1.20 to 2.30; p < 0.004).

Conclusion:

Patients with type 2 diabetes who are undergoing CABG surgery experience significantly more total operative mortality compared to nondiabetic patients, even after controlling for multiple variables. There was no difference between the groups for 12 morbidity outcomes.

Section snippets

Materials and Methods

We conducted a prospective hospitalization cohort study. Patients entered the cohort on admission to the hospital and exited the cohort 30 days after hospital discharge. The study population consisted of patients undergoing CABG surgery by the Cardiovascular Thoracic Surgery Group, located in Cincinnati, OH. The inclusion criteria included CAGB surgery between October 1, 1993, and July 1, 2002, and age > 18 years. The exclusion criteria included any other surgery performed simultaneously with

Results

During the study period, 9,551 patients had CABG surgery. A total of 6,711 patients met our inclusion criteria and were available for our analysis. This consisted of 2,178 patients with type 2 diabetes and 4,533 nondiabetic patients. Among the diabetic patients, diabetes was controlled by diet in 247 patients and by oral medication in 1,207 patients, and 724 patients were insulin-dependent.

Univariate analysis comparing diabetic status with the three demographic variables and the 13

Discussion

In this study, we determined the impact of diabetes mellitus on morbidity and total operative mortality after coronary bypass surgery. This study has the advantage of being prospective and including a relatively high prevalence of diabetic patients (32%). Univariate analysis revealed that the diabetic patients had more cardiovascular comorbidities at the time of surgery compared to nondiabetic patients, even though there was no significant difference in age. This is similar to the findings of

Conclusion

Patients with type 2 diabetes who are undergoing CABG surgery experience significantly more total operative mortality compared to nondiabetic patients, even after controlling for multiple variables. There was no difference between diabetic patients and nondiabetic patients for 12 morbidity outcomes.

ACKNOWLEDGMENT

The authors would like to acknowledge the assistance of Dr. Loren F. Hiratzka in the collection and quality control of the data for this publication.

References (19)

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  • Incidence of cardiovascular events and vascular interventions in patients with type 2 diabetes

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    Diabetes is associated with an increased risk of atherosclerotic cardiovascular complications such as MI, stroke, renal disease and peripheral artery disease [2,3]. For example, T2DM is associated with a more than two-fold increase in the rate of MI and all-cause mortality [4], while having a poorer outcome after coronary revascularization [5–8] and bypass grafting [9–10]. This increased risk associated with T2DM is not limited to coronary artery disease (CAD) but extends to both ischemic and haemorrhagic stroke [11], including a poorer functional outcome and cognitive recovery afterwards [12–14].

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