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Surgery for coronary artery disease in patients with diabetes mellitus
Insights
Diabetic patients with coronary artery disease (CAD) undergoing aortocoronary bypass grafting (CABG) experienced similar outcomes to non-diabetic patients. This study found comparable symptom relief and survival rates for both groups after surgery.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Clinical Outcomes Research
Background:
- Occlusive coronary artery disease (CAD) is a significant health concern.
- Diabetes mellitus is a common comorbidity in patients with CAD.
- The impact of diabetes on outcomes following aortocoronary bypass grafting (CABG) requires further investigation.
Purpose of the Study:
- To evaluate the short-term and medium-term results of CABG in diabetic patients compared to non-diabetic patients.
- To assess differences in comorbidities, perioperative events, and long-term survival between the two groups.
Main Methods:
- Retrospective analysis of 600 consecutive patients undergoing CABG between 1977 and 1982.
- Comparison of outcomes between 40 diabetic patients and 560 non-diabetic patients.
- Data collection included comorbidities, surgical details, perioperative events, and follow-up for symptom relief and survival.
Main Results:
- Diabetic patients had a higher frequency of hypertension and peripheral vascular disease.
- No significant differences were observed in unstable angina, triple-vessel disease, emergency surgery, left ventricular dysfunction, perioperative myocardial infarction, or hospital morbidity/mortality.
- At a mean follow-up of 3.7-3.9 years, diabetic and non-diabetic patients showed no significant difference in symptom relief or survival.
Conclusions:
- Diabetic patients with coronary artery disease can be offered bypass surgery.
- CABG provides good short-term and medium-term results for diabetic patients.
- Diabetes mellitus does not appear to be a contraindication for CABG, with comparable outcomes to non-diabetic individuals.
Abstract:
The results of surgery for occlusive coronary artery disease were studied in 600 consecutive, unselected patients who underwent aortocoronary bypass grafting between Jan. 1, 1977 and Dec. 31, 1982. Forty (7%) of these patients had diabetes mellitus, requiring medication. Sixteen of the 40 patients were insulin-dependent, the remainder required oral hypoglycemic agents. The frequency of previous myocardial infarction, hypertension and peripheral vascular disease in the groups of nondiabetic and diabetic patients was 38% and 62.5%, 12% and 22.5%, and 10.5% and 25% respectively. There was no significant difference in the rate of unstable angina, triple-vessel disease, emergency surgery, left ventricular dysfunction, myocardial infarction perioperatively and hospital morbidity or mortality in the two groups. On coronary angiography, 82% of coronary arteries in diabetic patients were graded as being small or moderate in size (less than 2 mm in diameter); at operation, 62% of these arteries were found to be 2 mm or more in diameter. At a mean follow-up of 3.9 years and 3.7 years in the nondiabetic and diabetic patients respectively (range from 1 to 6 years), no significant difference was noted with regard to relief of symptoms or survival in the two groups. It is concluded that diabetic patients with coronary artery disease can be offered bypass surgery with good short-term and medium-term results.