Diabetes mellitus and its impact on long-term outcomes after coronary artery bypass graft surgery
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Diabetes mellitus (DM) is an important risk factor for accelerated atherosclerosis and increases cardiovascular disease. Several studies found a higher mortality rate in postoperative diabetic patients than in non-diabetic patients. However, other studies found conflicting evidence on bypass graft dysfunction in patients with diabetes mellitus. We therefore investigated the influence of diabetes mellitus on the long-term outcome after coronary artery bypass surgery (CABG). In this prospective study, 936 consecutive CABG patients were included. These patients were divided into three groups: patients without diabetes mellitus, patients with diabetes mellitus using oral drugs (non-insulin-treated DM) and patients with diabetes mellitus using insulin (insulin-treated DM). The three groups were compared for mortality and (angiographic) bypass graft dysfunction. Of the 936 included patients, 720 (76.8%) patients were non-diabetics, 138 (14.7%) were non-insulin-treated DM, and 78 (8.3%) patients were insulin-treated DM. Follow-up was achieved in all patients, at a mean of 33 months. Mortality was significantly higher in patients with insulin-treated DM, compared with non-insulin-treated DM or non-diabetic patients (P = 0.003). Fourteen (1.5%) patients suffered a myocardial infarction after CABG. A coronary angiography was performed in 77 (8.2%) patients during follow-up, proven bypass graft dysfunction was found in 41 (53.2%) patients. There was no significant difference in bypass graft dysfunction between the three groups. Diabetes mellitus has a significant impact on long-term follow-up after coronary surgery. Particularly insulin dependency is related to an increased mortality. However, diabetes has no influence on angiographically proven bypass graft dysfunction.
KeywordsCoronary artery bypass graft surgery Diabetes mellitus Mortality Bypass graft dysfunction
The authors would like to acknowledge Sophie Umans for helping in data entry.
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