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[Mortality and morbidity after coronary bypass surgery in high-risk patients]
O Risum1, O Arafa, J L Svennevig
1Kirurgisk avdeling A, Rikshospitalet, Oslo.
Insights
Diabetic patients undergoing coronary artery bypass surgery had higher total mortality but similar early outcomes. Reduced ejection fraction significantly increased early and total mortality risk.
Area of Science:
- Cardiovascular Surgery
- Diabetology
- Clinical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Understanding long-term outcomes in specific patient subgroups, such as diabetics and those with reduced ejection fraction, is crucial.
Purpose of the Study:
- To compare early and late outcomes of CABG in diabetic versus non-diabetic patients.
- To evaluate the impact of ejection fraction on mortality and morbidity after CABG.
- To assess gender-based differences in CABG outcomes.
Main Methods:
- Retrospective analysis of 1025 patients (113 women, 912 men) undergoing CABG between 1982 and 1986.
- Follow-up data collected until January 1993.
- Comparison of outcomes including early mortality, recurrent angina, non-fatal myocardial infarction, and total mortality between diabetic and non-diabetic groups, and by ejection fraction and gender.
Main Results:
- No significant differences in early mortality, recurrent angina, or non-fatal myocardial infarction between diabetic and non-diabetic patients.
- Total mortality was 1.87 times higher in the diabetic group.
- Patients with ejection fraction ≤40% had a 10.2-fold higher early mortality.
- A linear relationship was observed between decreased ejection fraction and increased total mortality.
- No significant gender-based differences in mortality or morbidity were found.
Conclusions:
- Diabetic patients experience higher total mortality after CABG, despite similar early risks.
- Reduced ejection fraction is a strong predictor of increased early and total mortality post-CABG.
- High-risk patients, including diabetics and those with low ejection fraction, benefit from CABG, though their risk profile remains elevated.
Abstract:
A total of 113 women and 912 men were submitted to coronary artery bypass surgery at Surgical Department A, Rikshospitalet between August 1982 and December 1986 and followed till January 1993. We found no difference in early mortality, recurrent angina pectoris or non-fatal myocardial infarction in diabetic patients compared to nondiabetic patients. However, total mortality was 1.87 times higher in the diabetic group. For patients with ejection fraction < or = 40%, early mortality was 10.2 times higher than for the reference group. For total mortality we found a practically linear relationship between increased mortality and falling ejection fraction values. We found no relationship between ejection fraction and recurrent angina and non-fatal myocardial infarction, neither did we find any difference in mortality and morbidity between women and men. Although a somewhat higher mortality and morbidity rate must be expected for high-risk patients, they seem to profit to the same extent from the favourable effects of coronary bypass surgery as other patients.