Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Antunes, Pedro E.; Oliveira, J. Ferrão de; Antunes, Manuel J.

doi:10.1016/j.ejcts.2008.05.008

Cited by 27 publications

(26 citation statements)

References 22 publications

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“…Thus, the combination of diabetes with some of these variables can justify its expression as a risk factor. Our observations related to diabetes were similar to other studies that have shown a higher proportion of diabetics in the group with prolonged hospitalization [9,16,18,21], and that this disorder, itself, is a risk factor for prolonged hospitalization [11,13]. However, other studies found no association between diabetes and risk for prolonged hospitalization [6,7,16].…”

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

confidence: 69%

“…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. Also, the use of CPB worsens glycemic control, may increase the frequency of these complications [20].…”

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

confidence: 59%

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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: 69%

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

confidence: 59%

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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“…18 Literature suggests that diabetes has been an independent risk factor for development of stroke in patients undergoing CABG. 30 In accordance to this, various studies also favour PCI with DES over CABG in terms of occurrence of cerebrovascular events in such patients (OR [95%CI] = 2.15[0.99-4.68]). 24 Additionally, a prospective study has reported that 42% of patients who underwent CABG have subtle cognitive impairment 5 years after surgery.…”

Section: Resultsmentioning

confidence: 77%

Clinical Outcomes after Triple Vessel Angioplasty in Diabetic Patients with Triple Vessel Coronary Artery Disease

Manzil¹

2017

JCDR

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Background: This study was intended to evaluate clinical outcomes in diabetic patients who underwent triple vessel angioplasty for treatment of triple vessel coronary artery disease. Methods: This was an observational, single centred study, which included a total of 27 diabetic patients who underwent triple vessel angioplasty at a tertiary care hospital from May 2010 to July 2012. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Results: Of 27 patients, 18 were males, and 55.6% were hypertensive. 70.4% of patients had normal left ventricular function. Total number lesions were 97 and the total stents implanted were 85. Event-free survival rate was 92.6% at a mean follow-up of 20.3 months. Overall 100% continued success was obtained with triple vessel angioplasty. Conclusion: Triple vessel angioplasty can be applied as favourable therapy as an alternative to surgical revascularization in selected diabetic patients. However, larger studies with long-term follow-up would warrant the effectiveness of triple vessel angioplasty in such patients. Key words: Angioplasty, Coronary Artery Disease, Diabetes, Multivessel Disease, Stents. Ashraf Safiya Manzil INTRODUCTIONGlobally, the prevalence of diabetes mellitus has been escalating since decades in affecting millions of people. 1 Diabetes poses to be a risk factor for cardiovascular disease, contributing to higher rates of myocardial infarction and cardiovascular mortality.2,3 Coexistence of diabetes and coronary artery disease (CAD) has been associated with increased mortality and morbidity, because diabetic patients have allied with larger burden of atherogenic risk factors, like hypertension, obesity, dyslipidemia, insulin resistance, elevated levels of plasma fibrinogen, 4 enhanced platelet reactivity and reduced responsiveness to antiplatelet agents. 5,6 Moreover, literature suggests that diabetics have smaller coronary vessel diameter, diffused lesions, and probably a dissimilar restenotic cascade than nondiabetic patients, thus being highly liable to atherosclerosis and having a greater requirement for undergoing repeat revascularizations, 7,8,9 thus leading to poor prognosis in such patients. 3,4,5,6,7,8,9,10 Optimal approach for treating multivessel coronary disease has been controversial 11 and triple vessel stenosis in diabetic patients make the matter worse. Though coronary artery bypass surgery (CABG) had been the conventional treatment for triple vessel disease, 12,13,14 due to presence of some limitations like angiographic features related to the extent, location, and nature of CAD, as well as geographic, demographic and clinical factors; preference of approach shifts to percutaneous coronary intervention (PCI) instead of CABG. 15 In addition, some patients have been poor candidates for CABG, lik...

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“…1 Compared with nondiabetic individuals, diabetic patients undergoing coronary artery bypass grafting (CABG) have worse outcomes, including higher mortality, and higher rates of morbidity in the forms of deep sternal instability, wound infection, stroke, renal dysfunction, and respiratory problems. [2][3][4][5][6] Moreover, longer intensive care unit and hospital stays, poorer postoperative physical functioning, and lower quality of life are evident. [2][3][4][5][6] Nonetheless, CABG is preferred over percutaneous coronary intervention (PCI) in patients undergoing diabetes treatment.…”

mentioning

confidence: 98%

“…[2][3][4][5][6] Moreover, longer intensive care unit and hospital stays, poorer postoperative physical functioning, and lower quality of life are evident. [2][3][4][5][6] Nonetheless, CABG is preferred over percutaneous coronary intervention (PCI) in patients undergoing diabetes treatment. 7,8 With demographic changes resulting in an increase of the elderly population, the incidence of diabetes mellitus is also expected to increase, as is the number of CABG surgeries.…”

mentioning

confidence: 98%

Impact of diabetes mellitus on patients over 70 years of age undergoing coronary artery bypass grafting

Mei

Wang

et al. 2010

Heart & Lung

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Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

Abstract: Despite worse demographic and clinical characteristics, diabetic patients could be surgically revascularized with low mortality and morbidity, comparable with control patients. Hence, our data do not support diabetes as a risk factor for significantly adverse early outcome following CABG.

Cited by 27 publications

References 22 publications

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

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

Clinical Outcomes after Triple Vessel Angioplasty in Diabetic Patients with Triple Vessel Coronary Artery Disease

Impact of diabetes mellitus on patients over 70 years of age undergoing coronary artery bypass grafting

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