Antunes Pedro E, de Oliveira J Ferrão, Antunes Manuel J
Cardiothoracic Surgery, University Hospital, Coimbra, Portugal.
Eur J Cardiothorac Surg. 2008 Aug;34(2):370-5. doi: 10.1016/j.ejcts.2008.05.008. Epub 2008 Jun 9.
We aimed at determining the effect of diabetes mellitus (diabetes) on short-term mortality and morbidity in a cohort of patients with ischemic disease undergoing coronary artery bypass surgery (CABG) at our institution.
A total of 4567 patients undergoing isolated CABG in a 10-year period were studied. Diabetes mellitus was present in 22.6% of the cases but the percentage increased from 19.1% in the beginning to 27% in the end of the study period (p<0.0001 for the decade time-trend). Compared with non-diabetic patients, the group with diabetes was older (61.5+/-8.4 years vs 60.4+/-9.5 years), had a higher body mass index (26.4+/-2.2 vs 26.0+/-2.2), comprised more women (17.5% vs 10.1%), and had a greater incidence of peripheral vascular disease (13.3% vs 8.8%), cerebrovascular disease (8.3% vs 4.3%), renal failure (2.7% vs 1.1%), cardiomegaly (14.0% vs 10.9%), class III-IV angina (43.4% vs 39.0%), triple-vessel disease (80.9% vs 73.7%) and patients with left ventricular dysfunction (all p<0.05). Demographic and peri-procedural data were registered prospectively in a computerized institutional database. Multivariate logistic regression was performed to assess the influence of diabetes as an independent risk factor for in-hospital mortality and morbidity.
The overall in-hospital mortality was 0.96% [n=44; diabetics: 1.0%, non-diabetics: 0.9% (p=0.74)]. The mortality of patients with diabetes decreased from 2.7% in the early period to 0.7% in the late period (p=0.03 for the time-trend). Postoperative in-hospital complications were comparable in the two groups in univariate analysis, with only cerebrovascular accident and prolonged length of stay being significantly higher in the diabetic patients (all p<0.05). In multivariate analysis, diabetes was not found to be an independent risk factor for in-hospital mortality (OR=0.61; 95% CI=0.28-1.30; p=0.19), but predicted the occurrence of mediastinitis (OR=1.80; 95% CI=1.01-3.22; p=0.049).
Despite worse demographic and clinical characteristics, diabetic patients could be surgically revascularized with low mortality and morbidity, comparable with control patients. Hence, our data do not support diabetes as a risk factor for significantly adverse early outcome following CABG.
我们旨在确定糖尿病对在我院接受冠状动脉搭桥手术（CABG）的缺血性疾病患者队列的短期死亡率和发病率的影响。
对10年间共4567例行单纯CABG的患者进行了研究。22.6%的病例存在糖尿病，但该比例从研究期开始时的19.1%增加到结束时的27%（十年时间趋势，p<0.0001）。与非糖尿病患者相比，糖尿病组年龄更大（61.5±8.4岁 vs 60.4±9.5岁），体重指数更高（26.4±2.2 vs 26.0±2.2），女性更多（17.5% vs 10.1%），外周血管疾病、脑血管疾病、肾衰竭、心脏扩大、III-IV级心绞痛、三支血管病变及左心室功能不全的发生率更高（均p<0.05）。人口统计学和围手术期数据前瞻性地记录在计算机化的机构数据库中。进行多因素逻辑回归分析以评估糖尿病作为住院死亡率和发病率独立危险因素的影响。
总体住院死亡率为0.96%[n = 44；糖尿病患者：1.0%，非糖尿病患者：0.9%（p = 0.74）]。糖尿病患者的死亡率从早期的2.7%降至后期的0.7%（时间趋势，p = 0.03）。单因素分析中，两组术后住院并发症相当，仅糖尿病患者的脑血管意外和住院时间延长显著更高（均p<0.05）。多因素分析中，未发现糖尿病是住院死亡率的独立危险因素（OR = 0.61；95%CI = 0.28 - 1.30；p = 0.19），但可预测纵隔炎的发生（OR = 1.80；95%CI = 1.01 - 3.22；p = 0.049）。
尽管糖尿病患者的人口统计学和临床特征较差，但手术血运重建后死亡率和发病率较低，与对照组患者相当。因此，我们的数据不支持糖尿病是CABG术后早期显著不良结局的危险因素。
