Outcomes after surgical revascularization in diabetic patients.

Autor:	Misfeld M; University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.; Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, NSW, Australia.; Medical School, University of Sydney, Sydney, Australia., Sandner S; Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Caliskan E; Charité Universitätsmedizin Berlin, Berlin, Germany.; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany., Böning A; Department of Cardiovascular Surgery, Medical Faculty, Justus-Liebig-University Giessen, Giessen, Germany., Aramendi J; Hospital de Cruces, Barakaldo, Spain., Salzberg SP; Swiss Ablation, Herz & Rhythmus Zentrum AG, Zurich, Switzerland., Choi YH; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany., Perrault LP; Montreal Heart Institute, Montreal, Canada., Tekin I; Manavgat Government Hospital, Manavgat, Turkey.; Bahçeşehir University Faculty of Medicine, İstanbul, Turkey., Cuerpo GP; Hospital General Universitario Gregorio Marañón, Madrid, Spain., Lopez-Menendez J; Hospital Universitario Ramon y Cajal, Madrid, Spain., Weltert LP; European Hospital, Rome, Italy., Adsuar-Gomez A; Virgen del Rocio University Hospital, Seville, Spain., Thielmann M; West-German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany., Serraino GF; Magna Graecia University of Catanzaro, Catanzaro, Italy., Doros G; Boston University, Boston, MA, USA., Borger MA; University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany., Emmert MY; Charité Universitätsmedizin Berlin, Berlin, Germany.; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany.
Jazyk:	angličtina
Zdroj:	Interdisciplinary cardiovascular and thoracic surgery [Interdiscip Cardiovasc Thorac Surg] 2024 Feb 02; Vol. 38 (2).
DOI:	10.1093/icvts/ivae014
Abstrakt:	Objectives: Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG. Methods: The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE. Results: Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05-1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10-2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12-3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87-1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE. Conclusions: In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
Databáze:	MEDLINE
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