Impact of Diabetes in Patients With Acute Myocardial Infarction Undergoing Coronary Artery Bypass Surgery Within 48
Katharina Huenges1, Nele Rainer-Schmidt1, Bernd Panholzer1
1Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Insights
Patients with non-insulin dependent diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery after acute myocardial infarction (AMI) face higher risks. Careful risk-benefit evaluation is crucial for this high-risk diabetic group.
Area of Science:
- Cardiology
- Diabetology
- Surgical Outcomes
Background:
- Coronary artery bypass graft (CABG) surgery benefits diabetic patients with coronary artery disease.
- The benefit of CABG in diabetic patients experiencing acute myocardial infarction (AMI) remains unclear.
Purpose of the Study:
- To evaluate the outcomes of CABG in patients with acute myocardial infarction (AMI), specifically comparing diabetic subgroups (insulin-dependent diabetes mellitus [IDDM] and non-insulin dependent diabetes mellitus [NIDDM]) with non-diabetic patients.
Main Methods:
- Retrospective analysis of 1,427 patients who underwent CABG within 48 hours of AMI diagnosis between 2001 and 2019.
- Categorization into non-diabetic, IDDM, and NIDDM groups.
- Comparison of perioperative risk profiles, postoperative complications, and long-term survival rates.
Main Results:
- Non-insulin dependent diabetes mellitus (NIDDM) patients exhibited the highest perioperative risk (EuroScore II 11.6) and increased sepsis and ventilation times.
- NIDDM patients had a higher incidence of wound healing complications (4.7%) and the highest 30-day mortality (18.3%).
- Long-term survival analysis up to 15 years showed significantly reduced survival in diabetic patients, particularly those with NIDDM.
Conclusions:
- Non-insulin dependent diabetes mellitus (NIDDM) patients undergoing urgent CABG after AMI face elevated short-term and long-term complication risks.
- A thorough risk-benefit assessment is essential for NIDDM patients considered for CABG in the context of AMI.
- Findings highlight the need for tailored management strategies for diabetic patients undergoing revascularization post-AMI.
Background:
Diabetic patients with coronary artery disease may benefit from elective coronary artery bypass graft (CABG) surgery. It is unknown whether this merit is transferable to patients with acute myocardial infarction (AMI) undergoing surgery.
Method:
A total of 1,427 patients underwent CABG within 48 hours of being diagnosed with AMI at the current institution between 2001 and 2019. Of these patients, 206 (14.4%) had insulin-dependent diabetes mellitus (IDDM) and 148 (10.4%) had non-insulin dependent diabetes mellitus (NIDDM). Retrospective data analysis was performed.
Results:
Patients with NIDDM showed the highest perioperative risk profile, with a EuroScore II of 11.6 (±10.3) compared with 7.8 (±8.0) in non-diabetic patients and 8.4 (±7.8) in patients with IDDM (p<0.001). Sub-analysis demonstrated a higher proportion of non-ST-elevation myocardial infarction patients in the NIDDM cohort compared with the IDDM cohort (70.9% vs 56.8%; p=0.005). Postoperatively, NIDDM patients had more sepsis (p<0.01) and longer ventilation times (p<0.001) compared with non-DM and IDDM patients (p<0.01). Wound healing complications were rare, but almost twice as high in NIDDM patients compared with non-DM and IDDM patients (4.7% vs 0.9% vs 2.4%, respectively). The 30-day mortality was highest in the NIDDM cohort (18.3% vs 11.3% vs 7.8%; p=0.012). Analysis of survival for up to 15 years revealed a significantly reduced survival of diabetic patients compared with non-diabetic patients, with lowest survival rates in NIDDM patients (p<0.001).
Conclusions:
Non-insulin dependent diabetes mellitus patients undergoing CABG within 48 hours of being diagnosed with AMI are at increased risk of short-term and long-term complications. Therefore, this particular group should undergo a careful evaluation concerning the expected risks and benefits of CABG in this setting.
