糖尿病对冠状动脉旁路移植术后早期和晚期结局的影响。

Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting.

作者信息

Thourani V H, Weintraub W S, Stein B, Gebhart S S, Craver J M, Jones E L, Guyton R A

机构信息

Department of Surgery, Emory Center for Outcomes Research, Emory University School of Medicine, Atlanta, Georgia, USA.

出版信息

Ann Thorac Surg. 1999 Apr;67(4):1045-52. doi: 10.1016/s0003-4975(99)00143-5.

DOI:10.1016/s0003-4975(99)00143-5

PMID:10320249

Abstract

BACKGROUND

Diabetes mellitus is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting.

METHODS

The impact of diabetes on short- and longterm follow-up after coronary artery bypass grafting was studied by comparing the outcomes between 9,920 patients without diabetes mellitus and 2,278 patients with diabetes from 1978 to 1993.

RESULTS

Compared with nondiabetic patients, the group with diabetes was older (62+/-10 years versus 60+/-10 years), comprised more women (31% versus 19%), had a greater incidence of hypertension (61% versus 44%) and previous myocardial infarction (51% versus 48%), had class III-IV angina more commonly (69% versus 63%), showed a higher incidence of congestive heart failure (11% versus 5%) or triple-vessel or left main disease (60% versus 50%), and had lower ejection fractions (0.54 versus 0.57) (all, p< or =0.05). Diabetic patients had a higher incidence of postoperative death (3.9% versus 1.6%) and stroke (2.9% versus 1.4%) (both, p< or =0.05), but not Q wave myocardial infarction (1.8% versus 2.9%). Diabetics had lower survival (5 years, 78% versus 88%; 10 years, 50% versus 71%; both, p< or =0.05) and lower freedom from percutaneous transluminal coronary angioplasty (5 years, 95% versus 96%; 10 years, 83% versus 86%; latter, p< or =0.05), but diabetics did not have lower freedom from either myocardial infarction (5-years, 92% versus 92%; 10-years, 80% versus 84%) or additional coronary artery bypass grafting (5-years, 98% versus 99%; 10-years, 90% versus 91%). Multivariate correlates of long-term mortality were diabetes, older age, reduced ejection fraction, hypertension, congestive heart failure, number of vessels diseased, and urgent or emergent operation.

CONCLUSIONS

Diabetics have a worse hospital and longterm outcome after coronary artery bypass grafting. The increased risk in such patients can only partially be explained by other demographic characteristics.

摘要

背景

糖尿病是冠状动脉搭桥术后发生严重发病和死亡的既定独立危险因素。

方法

通过比较1978年至1993年间9920例非糖尿病患者和2278例糖尿病患者的结局，研究糖尿病对冠状动脉搭桥术后短期和长期随访的影响。

结果

与非糖尿病患者相比，糖尿病组年龄更大（62±10岁对60±10岁），女性更多（31%对19%），高血压发病率更高（61%对44%），既往心肌梗死发生率更高（51%对48%），Ⅲ-Ⅳ级心绞痛更常见（69%对63%），充血性心力衰竭或三支血管或左主干病变发生率更高（60%对50%），射血分数更低（0.54对0.57）（所有比较，p≤0.05）。糖尿病患者术后死亡（3.9%对1.6%）和中风（2.9%对1.4%）的发生率更高（两者均p≤0.05），但Q波心肌梗死发生率无差异（1.8%对2.9%）。糖尿病患者生存率更低（5年时，78%对88%；10年时，50%对71%；两者均p≤0.05），免于经皮冠状动脉腔内血管成形术的比例更低（5年时，95%对96%；10年时，83%对86%；后者p≤0.05），但糖尿病患者免于心肌梗死（5年时，92%对92%；10年时，80%对84%）或再次冠状动脉搭桥术（5年时，98%对99%；10年时，90%对91%）的比例并无降低。长期死亡率的多变量相关因素包括糖尿病、年龄较大、射血分数降低、高血压、充血性心力衰竭、病变血管数量以及急诊或紧急手术。