Mohammadi Siamak, Dagenais François, Mathieu Patrick, Kingma John G, Doyle Daniel, Lopez Stephane, Baillot Richard, Perron Jean, Charbonneau Eric, Dumont Eric, Metras Jacques, Desaulniers Denis, Voisine Pierre
Department of Cardiac Surgery, Laval Hospital, Québec City, QC, Canada.
Circulation. 2007 Sep 11;116(11 Suppl):I220-5. doi: 10.1161/CIRCULATIONAHA.106.681320.
The objective of this study was to identify the impact of diabetes and related comorbidities, namely chronic renal failure, peripheral vascular disease, and low ejection fraction (<35%), on long-term survival of patients undergoing coronary artery bypass graft surgery.
A unicenter study was conducted on 9125 survivors of isolated coronary artery bypass graft surgery between 1992 and 2002. There were 6581 nondiabetic patients and 2544 diabetics, including 1809 patients with noninsulin-dependent diabetes mellitus and 735 patients with insulin-dependent diabetes mellitus. Cardiac-specific survival at 5 and 10 years was lower in insulin-dependent diabetes mellitus compared with both nondiabetic mellitus patients and patients with noninsulin-dependent diabetes mellitus (P<0.0001). However, freedom from cardiac-related death was similar for patients with noninsulin-dependent diabetes mellitus and nondiabetes mellitus patients up to 6 years (P=0 0.08) after surgery and was significantly lower thereafter (P=0.004). Cardiac-specific survival after coronary artery bypass graft surgery in patients with one or more comorbidities was comparable (P=0.4) for both nondiabetes mellitus patients and patients with noninsulin-dependent diabetes mellitus, but was significantly lower for those requiring insulin therapy (P<0.0001). Noninsulin-dependent diabetes mellitus was not an independent predictor of long-term cardiac death (hazard ratio: 1.09, P=0.41); however, insulin-dependent diabetes mellitus, chronic renal failure, peripheral vascular disease, and low ejection fraction were all independent risk factors for late cardiac death (all P<0.0001). The impact of comorbidities on the long-term risk of cardiac death was similar for the 3 groups.
Noninsulin-dependent diabetes is not an independent predictor of late cardiac death after coronary artery bypass graft surgery, because cardiac-related survival is similar to that of nondiabetic patients for 6 years after surgery. In diabetic and nondiabetic patients, cardiac survival is adversely affected by the need for insulin therapy and/or the presence and number of comorbidities such as chronic renal failure, peripheral vascular disease, and low ejection fraction.
本研究的目的是确定糖尿病及相关合并症，即慢性肾衰竭、外周血管疾病和低射血分数（<35%），对接受冠状动脉搭桥手术患者长期生存的影响。
对1992年至2002年间9125例单纯冠状动脉搭桥手术幸存者进行了一项单中心研究。其中非糖尿病患者6581例，糖尿病患者2544例，包括1809例非胰岛素依赖型糖尿病患者和735例胰岛素依赖型糖尿病患者。与非糖尿病患者和非胰岛素依赖型糖尿病患者相比，胰岛素依赖型糖尿病患者5年和10年的心脏特异性生存率较低（P<0.0001）。然而，非胰岛素依赖型糖尿病患者和非糖尿病患者术后6年内心脏相关死亡的自由度相似（P=0.08），此后显著降低（P=0.004）。对于非糖尿病患者和非胰岛素依赖型糖尿病患者，有一项或多项合并症的患者冠状动脉搭桥手术后的心脏特异性生存率相当（P=0.4），但需要胰岛素治疗的患者显著降低（P<0.0001）。非胰岛素依赖型糖尿病不是长期心脏死亡的独立预测因素（风险比：1.09，P=0.41）；然而，胰岛素依赖型糖尿病、慢性肾衰竭、外周血管疾病和低射血分数都是晚期心脏死亡的独立危险因素（均P<0.0001）。合并症对三组患者长期心脏死亡风险的影响相似。
非胰岛素依赖型糖尿病不是冠状动脉搭桥手术后晚期心脏死亡的独立预测因素，因为术后6年内心脏相关生存率与非糖尿病患者相似。在糖尿病和非糖尿病患者中，胰岛素治疗的需求和/或慢性肾衰竭、外周血管疾病和低射血分数等合并症的存在及数量会对心脏生存率产生不利影响。
