Effects and outcomes of cardiac surgery in patients with cardiometabolic syndrome

Abstract

Introduction Cardiometabolic syndrome (CMS) is diabetes mellitus (or insulin resistance) plus any two of the following risk factors: hypertension, obesity, and hyperlipidemia. The correlation of metabolic syndrome with cardiovascular disease and the increase in the prevalence of patients with risk factors have solidified the importance of continued focus on metabolic syndrome. We retrospectively evaluated single‐center data to determine if there is an association between CMS and outcomes. Methods The local Society of Thoracic Surgeons Adult Cardiac Database was queried for consecutive coronary bypass (CABG) cases from 2002 to 2010. Short and long‐term outcomes were compared between groups of patients with CMS and then risk‐adjusted using multiple regression models with adjusted odds ratios and hazard ratios. Results Of 11 021 CABG cases, 3881 (35.2%) had CMS, with an annual prevalence that increased from 32% to 40% during the study. Patients with CMS were more likely to have prior cerebrovascular diseases, strokes, renal insufficiency, and worse New York Heart Association status. Unadjusted postoperative comparisons revealed that patients with CMS had higher rates of stroke, renal failure, dialysis, deep sternal wound infection, and longer intensive care unit and hospital length of stay. Risk‐adjusted odds ratios did not reveal a significant impact on short‐term outcomes, however, adjusted hazard ratios continued to demonstrate significant decreases in long‐term survival in patients with CMS. Conclusions Patients with CMS were more likely to present with increased comorbidities. Patients with CMS undergoing CABG were at risk for worse short‐term secondary postoperative outcomes and reduced long‐term survival. The data supports the need for further investigation for risk reduction surrounding operative revascularization.

Risk of complications rise with coronary artery disease and diabetes mellitus after endobronchial valve placement in severe heterogeneous emphysema

“…We did not assess therapy for DM and CAD, pre‐procedure glucose control, or evidence of end organ damage from either DM or CAD. Cardiometabolic syndrome with DM and obesity is associated with worsened outcomes after coronary artery bypass surgery 31 . In our cohort, BMI was not significantly different between those with or without complications but obesity was not commonly present.…”

Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals

“…Across these studies, a total of 333 488 patients with MetS underwent surgery versus 1 449 817 surgical patients without MetS. We found fifteen of 44 studies reported an increased risk of mortality across a range of surgical types including bariatric 39 , 43 , 57 , cardiac 19 , 42 , ear, nose, and throat (ENT) 35 , emergency 31 , endocrine 59 , 84 , gastrointestinal 40 , hepatobiliary 23 , 33 , 34 , neurosurgery 49 , and orthopaedic 47 . Twenty-five studies considered for meta-analysis found no association with 30-day mortality between MetS and non-MetS patients across a wide range of surgical types.…”

“…Inclusion and Exclusion Criteria). The most commonly reported types of surgery were orthopaedic (22%) 5 , 6 , 15 , 26 , 27 , 29 , 46 – 48 , 67 , 72 , 73 , 75 , 78 , cardiac (21%) 19 , 20 , 37 , 38 , 41 , 42 , 50 , 51 , 54 , 63 , 64 , 69 , 76 , vascular (13%) 4 , 24 , 53 , 62 , 65 , 68 , 70 , 79 , hepatobiliary (11%) 50 – 56 , gastroenterology (6%) 57 – 60 , bariatric (5%) 39 , 43 , 57 , urology (5%) 21 , 58 , 74 , and plastics (5%) 52 , 56 , 77 (see Table 3 . Included Studies).…”

“…Included Studies). Most studies reported North America data ( n =40) 4 – 6 , 15 , 23 , 27 , 30 – 35 , 38 – 40 , 43 , 46 – 49 , 52 , 53 , 55 – 62 , 65 – 67 , 70 , 73 , 75 – 78 , 80 , with the remaining spanning Europe 19 , 21 , 22 , 24 , 28 , 42 , 44 , 50 , 51 , 64 , 68 , 81 , the Middle East 20 , Asia 37 , 41 , 45 , 71 , 72 , 74 , 82 , 83 , Africa 63 , and South America 54 . The assessed risk of bias of the included studies ranged from 5 to 8 (fair to good) out of a possible 9 stars when assessed using the NOS.…”

Patients after coronary artery bypass grafting with special reference to cardiometabolic syndrome, exercise and sleep

“…Patients after coronary artery bypass grafting with special reference to cardiometabolic syndrome, exercise and sleep I have read with great interest by Zapata et al, 1 in which the authors evaluated the effects and outcomes of coronary artery bypass graft (CABG) in patients with cardiometabolic syndrome (CMS). The risk of CMS for long-term survival significantly increased, which might be related to comorbidities by CMS.…”