Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
Karolinska Institutet, Department of Clinical Sciences and Education, Sachs' Children's Hospital, Stockholm, Sweden.
J Am Coll Cardiol. 2015 Apr 28;65(16):1644-1652. doi: 10.1016/j.jacc.2015.02.052.
Patients with diabetes mellitus (DM) have an increased risk of adverse outcomes after coronary artery bypass grafting (CABG). Previous studies have reported prognosis in relation to treatment with or without insulin, and not to the type of diabetes.
This study investigated long-term survival in patients with type 1 DM (T1DM) and type 2 DM (T2DM) following CABG.
We included all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent primary isolated CABG in Sweden during 2003 through 2013. We identified patients with T1DM or T2DM in the Swedish National Diabetes Register. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality in patients with T1DM or T2DM.
In total, 39,235 patients were included, of whom 725 (1.8%) had T1DM and 8,208 (21%) had T2DM. Patients with TDM1 were younger (59 vs. 67 years), had reduced kidney function (31% vs. 24%), and had peripheral vascular disease (21% vs. 11%) more often than patients with TDM2 or no diabetes. During a mean follow-up of 5.9±3.2 years (230,085 person-years), 6,765 (17%) patients died. Among patients with T1DM, 152 (21%) died, and among patients with T2DM, 1,549 (19%) died. Adjusted hazard ratio (95% confidence interval) for death in patients with T1DM and T2DM, compared with patients without diabetes, were 2.04 (1.72 to 2.42), and 1.11 (1.05 to 1.18), respectively.
Patients with T1DM had more than double the long-term risk of death after CABG compared with patients without diabetes. The long-term risk of death in patients with T2DM was only slightly increased.
患有糖尿病（DM）的患者在冠状动脉旁路移植术（CABG）后发生不良结局的风险增加。先前的研究报告了与使用胰岛素或不使用胰岛素相关的预后，而不是与糖尿病类型相关的预后。
本研究调查了 CABG 后 1 型糖尿病（T1DM）和 2 型糖尿病（T2DM）患者的长期生存情况。
我们纳入了 2003 年至 2013 年期间在瑞典接受初次单独 CABG 的 SWEDEHEART（瑞典基于推荐疗法的心脏病循证治疗增强和开发网络系统）注册中的所有患者。我们在瑞典国家糖尿病登记处中确定了 T1DM 或 T2DM 患者。我们计算了 T1DM 或 T2DM 患者全因死亡率的风险比（HR）及其 95%置信区间（CI）。
共纳入 39235 例患者，其中 725 例（1.8%）患有 T1DM，8208 例（21%）患有 T2DM。与 T2DM 或无糖尿病患者相比，T1DM 患者更年轻（59 岁 vs. 67 岁），肾功能降低（31% vs. 24%），且外周血管疾病更常见（21% vs. 11%）。在平均 5.9±3.2 年（230085 人年）的随访期间，6765 例（17%）患者死亡。在 T1DM 患者中，有 152 例（21%）死亡，在 T2DM 患者中，有 1549 例（19%）死亡。与无糖尿病患者相比，T1DM 和 T2DM 患者死亡的调整后 HR（95%CI）分别为 2.04（1.72 至 2.42）和 1.11（1.05 至 1.18）。
与无糖尿病患者相比，T1DM 患者在 CABG 后长期死亡风险增加了一倍以上。T2DM 患者的长期死亡风险仅略有增加。
