糖尿病患者冠状动脉搭桥手术后的长期预后

Long-term outcomes after coronary artery bypass surgery in patients with diabetes.

作者信息

Axelsson Tomas Andri, Adalsteinsson Jonas A, Arnadottir Linda O, Helgason Dadi, Johannesdottir Hera, Helgadottir Solveig, Orrason Andri Wilberg, Andersen Karl, Gudbjartsson Tomas

机构信息

Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.

Internal Medicine Services, Landspitali University Hospital, Reykjavik, Iceland.

出版信息

Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):685-690. doi: 10.1093/icvts/ivaa009.

DOI:10.1093/icvts/ivaa009

PMID:32087014

Abstract

OBJECTIVES

Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications.

METHODS

This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes.

RESULTS

Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27-4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P < 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P < 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53-2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23-1.75).

CONCLUSIONS

Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

摘要

目的

我们的目的是研究在整个人口中接受冠状动脉旁路移植术（CABG）的糖尿病患者的结局，主要关注长期死亡率和并发症。

方法

这是一项对2001年至2016年期间在冰岛接受单纯原发性CABG的所有患者进行的全国性回顾性分析。在中位随访8.5年期间，比较了糖尿病患者和非糖尿病患者的总生存率以及主要不良心脏和脑血管事件的复合终点。多变量回归分析用于评估糖尿病对短期和长期结局的影响。

结果

在总共2060例患者中，356例（17%）患有糖尿病。糖尿病患者的体重指数较高（29.9对27.9kg/m²），更常患有高血压（83%对62%）和慢性肾病（估计肾小球滤过率≤60ml/min/1.73m²，21%对14%）。在对混杂因素进行调整后，糖尿病患者的手术死亡率风险增加[比值比2.52，95%置信区间（CI）1.27 - 4.80]。糖尿病患者的5年总生存率（85%对91%，P < 0.001）以及5年无主要不良心脏和脑血管事件生存率也较低（77%对82%，P < 0.001）。对潜在混杂因素进行调整的Cox回归分析表明，糖尿病诊断显著预测全因死亡率[风险比（HR）1.87，95%CI 1.53 - 2.29]以及主要不良心脏和脑血管事件风险增加（HR 1.47，95%CI 1.23 - 1.75）。