Prognosis and Complications of Diabetic Patients Undergoing Isolated Coronary Artery Bypass Surgery

Santos, Karen Alcantara Queiroz; Berto, Bharbara; Sousa, Alexandre Gonçalves de; Costa, Fernando

doi:10.5935/1678-9741.20160002

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…Even though diabetes increases 2.3 times the risk for cardiovascular survival, the 10-year cardiovascular survival is excellent (85.9%). In contrast to our findings, other authors have shown than diabetes per se is not an independent predictor for poor prognosis [ 18 ] .…”

Section: Discussioncontrasting

confidence: 99%

CABG and Preoperative use of Beta-Blockers in Patients with Stable Angina are Associated with Better Cardiovascular Survival

Dayan¹,

Pérez²,

Silva³

et al. 2018

Braz J Cardiovasc Surg

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ObjectiveIn contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes.MethodsRetrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry.ResultsWe included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age.ConclusionCoronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.

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Section: Discussioncontrasting

confidence: 99%

CABG and Preoperative use of Beta-Blockers in Patients with Stable Angina are Associated with Better Cardiovascular Survival

Dayan¹,

Pérez²,

Silva³

et al. 2018

Braz J Cardiovasc Surg

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“…The comorbidities in developing countries like Chinese patients are also different from Western population. In our derivation cohort, the ratio of hypertension and diabetes mellitus is also remarkable, lower than the previous develop population [ 19 ] .…”

Section: Discussionmentioning

confidence: 72%

Validation of Four Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury in Chinese Patients

Jiang¹,

Xu²,

Shen³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveTo assess the clinical value of four models for the prediction of cardiac surgery-associated acute kidney injury (CSA-AKI) and severe AKI which renal replacement therapy was needed (RRT-AKI) in Chinese patients.Methods1587 patients who underwent cardiac surgery in the department of cardiac surgery in the Zhongshan Hospital, Fudan University, between January 2013 and December 2013 were enrolled in this research. Evaluating the predicting value for cardiac surgery-associated AKI (AKICS score) and RRT-AKI (Cleveland score, SRI and Mehta score) by Hosmer-Lemeshow goodness-of-fit test for the calibration and area under receiver operating characteristic curve (AUROC) for the discrimination.ResultsBased on 2012 KDIGO (Kidney Disease: Improving Global Outcomes) AKI definition, the incidence of AKI and RRT-AKI was 37.4% (594/1587) and 1.1% (18/1587), respectively. The mortality of AKI and RRT-AKI was 6.1% (36/594) and 66.7% (12/18), respectively, while the total mortality was 2.8% (44/1587). The discrimination (AUROC=0.610) for the prediction of CSA-AKI of AKICS was low, while the calibration (x2=7.55, P=0.109) was fair. For the prediction of RRT-AKI, the discrimination of Cleveland score (AUROC=0.684), Mehta score (AUROC=0.708) and SRI (AUROC=0.622) were not good; while the calibration of them were fair (Cleveland score x2=1.918, P=0.166; Mehta score x2=9.209, P=0.238; SRI x2=2.976, P=0.271).ConclusionIn our single-center study, based upon valve surgery dominant and less diabetes mellitus patients, according to KDIGO AKI definition, the predictive value of the four models, combining discrimination and calibration, for respective primary event, were not convincible.

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“…High postoperative sepsis in our study is a peculiar problem of the developing countries 44(20.9%) (Table 3). Diabetes is a known risk factor for septic complications after CABG and also has a negative impact on their long‐term survival 24 . Mean HbA1C level of the cohort was 8.2 and was 9.6 for those who developed sepsis.…”

Section: Discussionmentioning

confidence: 99%

Midterm outcome of off‐pump CABG for severe LV dysfunction—Does LV size and function predict their midterm outcome?

et al. 2021

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Background The superiority of surgical revascularization in ischemic cardiomyopathy is established beyond doubt, and off‐pump CABG (OP‐CABG) is a safe way of revascularization in this high‐risk subset. Data on the effect of postoperative ventricular function and size on their midterm outcome is scarce. Materials and Methods A retrospective study was done on 211 consecutive patients with severe LV dysfunction who underwent OP‐CABG from January 2017 to December 2018. Data were collected from the institutional database. Their operative and midterm outcomes were statistically analyzed. Results The mean age of the cohort was 58.4 ± 8.3 years. An average number of grafts was 3.1 ± 0.8 (cumulative intended number of grafts—3). Operative mortality was 10.9%. Preoperative NYHA class (p < .0001; OR, 19.72) and postoperative IABP insertion (p < .008; OR, 88.75) were independent predictors of operative mortality. The mean follow‐up period was 3.14 ± 0.07 years, was 97.4% complete with cardiac mortality of 5.8%. Postoperative LVEF (p = .002; OR, 0.868) and LV dimensions (systole & diastole) (p = .013, OR = 1.182 and p = .036, OR = 1.184, respectively) were independent predictors of midterm mortality. Midterm major adverse cardiovascular event‐free survival of operative survivors was 89%. There was no correlation between postoperative LV dimension and NYHA status(p > .05). Myocardial viability was not associated with early (p = .17) or midterm mortality (p = .676). Conclusion OP‐CABG can achieve complete revascularization in patients with severe LV dysfunction with good midterm outcomes, albeit with high early operative mortality. Postoperative change in LV dimension and EF are predictors of midterm mortality.

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Prognosis and Complications of Diabetic Patients Undergoing Isolated Coronary Artery Bypass Surgery

Cited by 13 publications

References 24 publications

CABG and Preoperative use of Beta-Blockers in Patients with Stable Angina are Associated with Better Cardiovascular Survival

CABG and Preoperative use of Beta-Blockers in Patients with Stable Angina are Associated with Better Cardiovascular Survival

Validation of Four Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury in Chinese Patients

Midterm outcome of off‐pump CABG for severe LV dysfunction—Does LV size and function predict their midterm outcome?

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