Diabetes and Coronary Revascularization

Flaherty, James; Davidson, Charles J.

doi:10.1001/jama.293.12.1501

Cited by 240 publications

(121 citation statements)

References 68 publications

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“…These observations support the fact that diabetes per se, is a risk factor for coronary heart disease [1,18] and its more severe degree [19]. Furthermore, diabetes is associated with a greater number of surgical complications such as perioperative myocardial infarction [20], prolonged MV [20], infection [18] and cerebrovascular accidents [18], which prolongs the ICU.…”

Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatsupporting

confidence: 53%

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Oliveira¹,

Turquetto²,

Tauil³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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353Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):353- ORIGINAL ARTICLE Abstract Introduction: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality.Objective: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards.Methods: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P ≤0.05 was considered statistically significant.Results: Hospital stay >3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction <50% (OR=3.04). Combining pre-and intraoperative factors, diabetes (OR=2.81), and including postoperative factors, presence of infection (OR=4.54) were predictors of prolonged hospitalization in the ward.Conclusion: Diabetes and smoking were predictors of intensive care unit outcome, and ejection fraction <50% of ward outcome. For the set of perioperative factors, prolonged hospitalization after isolated coronary artery bypass grafting was associated with mechanical ventilation >24 hours for the intensive care unit and presence of infection for the ward.Descriptors: Risk factors. Myocardial revascularization. Hospitalization. ResumoIntrodução: Características do paciente e da cirurgia de revascularização do miocárdio podem predispor à internação prolongada, aumentando custos e a morbimortalidade.Objetivo: Avaliar fatores de risco individuais e transoperató-rios para internação prolongada na unidade de terapia intensiva e na enfermaria. 354Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(3):353-63 Oliveira EK, et al. -Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting productivity [4,8], affecting family budgets, quality of life and increasing costs [1]. Bashour et al. [7] showed that, after cardiac surgery, many patients with prolonged hospital stay died soon after discharge and that the functional status of those who survived for a longer period was worse when compared with those who recovered faster. RevIn this context, the objective of this study was to identify pre-, intra-and postoperative risk factors for long hospitalizations in the ICU or the ward, of patients undergoing isolated CABG surgery w...

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Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatsupporting

confidence: 53%

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Oliveira¹,

Turquetto²,

Tauil³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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“…These fi ndings were not only a result of the inclusion of the BARI trial since the trend in survival remains after exclusion of that trial. Six early randomized controlled trials (with a total of 950 diabetics) compared CABG and PCI [23]. In diabetic patients with multivessel CAD a survival advantage and fewer repeat revascularization procedures were demonstrated with an initial surgical revascularization.…”

Section: Diabetes Mellitus: Data Previous To Freedommentioning

confidence: 99%

“…There were similar results of the composite safety endpoint (death/stroke/ /MI) and/or repeat revascularization in the PES and CABG groups in the lowest SYNTAX score tertile (score 0-22), representing the lowest lesion complexity. However, as well in the medium (SYNTAX score [23][24][25][26][27][28][29][30][31][32] as in the high (SYNTAX score ≥ 33) groups, MACCE was signifi cantly higher in the PES arm compared with the CABG arm: 21.0% vs. 36.2%, p = 0.04 for the intermediate and 18.5% vs. 45.9%, p < 0.001 for the highest SYNTAX score, respectively. Furthermore, Hannan et al [28] have shown that for patients with multivessel disease, CABG is associated with lower mortality rates than the treatment with DES.…”

Section: Diabetes Mellitus: Data Previous To Freedommentioning

confidence: 99%

Optimal revascularization in diabetes after the FREEDOM trial: Were the controversies finally settled?

Tenenbaum

Fisman

2013

Cardiol J

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“…For example, it is generally accepted that contemporary patients referred for surgery are older and more medically complex [73]. For example, many patients referred for CABG are diabetic, a condition that is notorious for more complicated and diffuse CAD [46,74]. In addition, it has been proposed that venous grafts in elderly may be of inferior quality relative to younger patients [75].…”

Section: Saphenous Vein Graft Conduitsmentioning

confidence: 99%