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Coronary artery bypass surgery in the diabetic patient
Insights
Coronary artery bypass grafting (CABG) is safe for diabetic patients, offering angina relief but increasing wound complications and long-term cardiac issues. Careful consideration of these risks is essential for optimal patient outcomes.
Area of Science:
- Cardiology
- Diabetology
- Vascular Surgery
Background:
- Diabetes mellitus significantly increases the risk of atherosclerotic coronary artery disease (CAD) and peripheral occlusive arterial disease.
- Diabetic patients face a threefold higher mortality risk from CAD compared to non-diabetic individuals.
Purpose of the Study:
- To evaluate the early and late postoperative outcomes of coronary artery bypass grafting (CABG) in diabetic patients compared to matched controls.
- To assess the safety and efficacy of CABG in managing coronary artery disease in the context of diabetes mellitus.
Main Methods:
- A comparative study involving 32 diabetic patients and 32 matched controls who underwent CABG.
- Analysis of perioperative complications, wound morbidity, and long-term outcomes including mortality, angina relief, and cardiac morbidity.
Main Results:
- No in-hospital mortality was observed in either group.
- Diabetic patients experienced significantly higher rates of wound morbidity and greater long-term cardiac morbidity (21.8% vs. 12.5%) compared to controls.
- Full angina relief was achieved in 75% of diabetic patients versus 87.5% of controls.
Conclusions:
- CABG is a safe surgical option for diabetic patients with coronary artery disease.
- While CABG provides satisfactory symptomatic relief, diabetic patients are prone to increased perioperative wound complications and higher long-term cardiac morbidity.
Abstract:
Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61 +/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months--35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.