Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease

Calafiore, Antonio M.; Mauro, Michele Di; Giammarco, Gabriele Di; Contini, Marco; Vitolla, Giuseppe; Iacò, Angela L.; Canosa, Carlo; D’Alessandro, Stefano

doi:10.1067/mtc.2003.73

Cited by 77 publications

(53 citation statements)

References 34 publications

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“…14 However, long-term survival of patients with diabetes after cardiac surgery has been less extensively studied and remains controversial. [15][16][17] In the present study, a large, unicenter regional database with 100% follow-up was used to examine longterm cardiac-specific survival, because cardiac death is the most frequent cause of death in patients with diabetes undergoing CABG surgery. 18 Our findings reveal that NIDDM is not an independent risk factor for long-term cardiac-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery

Mohammadi¹,

Dagenais²,

Mathieu³

et al. 2007

Circulation

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Background— The objective of this study was to identify the impact of diabetes and related comorbidities, namely chronic renal failure, peripheral vascular disease, and low ejection fraction (<35%), on long-term survival of patients undergoing coronary artery bypass graft surgery. Methods and Results— A unicenter study was conducted on 9125 survivors of isolated coronary artery bypass graft surgery between 1992 and 2002. There were 6581 nondiabetic patients and 2544 diabetics, including 1809 patients with noninsulin-dependent diabetes mellitus and 735 patients with insulin-dependent diabetes mellitus. Cardiac-specific survival at 5 and 10 years was lower in insulin-dependent diabetes mellitus compared with both nondiabetic mellitus patients and patients with noninsulin-dependent diabetes mellitus ( P <0.0001). However, freedom from cardiac-related death was similar for patients with noninsulin-dependent diabetes mellitus and nondiabetes mellitus patients up to 6 years ( P =0 0.08) after surgery and was significantly lower thereafter ( P =0.004). Cardiac-specific survival after coronary artery bypass graft surgery in patients with one or more comorbidities was comparable ( P =0.4) for both nondiabetes mellitus patients and patients with noninsulin-dependent diabetes mellitus, but was significantly lower for those requiring insulin therapy ( P <0.0001). Noninsulin-dependent diabetes mellitus was not an independent predictor of long-term cardiac death (hazard ratio: 1.09, P =0.41); however, insulin-dependent diabetes mellitus, chronic renal failure, peripheral vascular disease, and low ejection fraction were all independent risk factors for late cardiac death (all P <0.0001). The impact of comorbidities on the long-term risk of cardiac death was similar for the 3 groups. Conclusions— Noninsulin-dependent diabetes is not an independent predictor of late cardiac death after coronary artery bypass graft surgery, because cardiac-related survival is similar to that of nondiabetic patients for 6 years after surgery. In diabetic and nondiabetic patients, cardiac survival is adversely affected by the need for insulin therapy and/or the presence and number of comorbidities such as chronic renal failure, peripheral vascular disease, and low ejection fraction.

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Section: Discussionmentioning

confidence: 99%

Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery

Mohammadi¹,

Dagenais²,

Mathieu³

et al. 2007

Circulation

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“…Diabetic patients are 2 to 3 times more likely to develop CHD, and experience worse clinical outcomes following an acute myocardial infarction, [1][2][3] coronary angioplasty, 4 and cardiac bypass surgery. [5][6][7] The reason for the worsened cardiovascular outcomes in diabetic patients is currently unclear. Preclinical animal studies suggest that there may be specific defects in diabetic cardiomyocytes which may be responsible including increased mitochondrial generation of reactive oxygen species, downregulation of the PI3-Akt survival kinase pathway, and reduced rates of adenosine triphosphate (ATP) synthesis (reviewed in refs [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Glimepiride Treatment Facilitates Ischemic Preconditioning in the Diabetic Heart

Hausenloy

Wynne

Mocanu

et al. 2012

J Cardiovasc Pharmacol Ther

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Aims: The diabetic heart is resistant to the myocardial infarct-limiting effects of ischemic preconditioning (IPC). This may be in part due to the downregulation of the phosphatidylinositol 3 0 -kinase-Akt pathway, an essential component of IPC protection. We hypothesized that treating the diabetic heart with the sulfonylurea, glimepiride, which has been reported to activate Akt, may lower the threshold required to protect the diabetic heart by IPC. Methods: Goto-Kakizaki rats (a type II lean model of diabetes) received glimepiride (20 mg/kg per d, by oral gavage) or vehicle for (a) 3 months (chronic treatment) or (b) 24 hours (subacute treatment). In the third group, glimepiride (10 mmol/L) was administered only to the isolated hearts on the Langendorff apparatus (acute treatment). All hearts were subjected to 35 minutes ischemia and 120 minutes reperfusion ex vivo, at the end of which infarct size was determined by tetrazolium staining. Preconditioning treatment comprised 1 (IPC-1) or 3 (IPC-3) cycles of 5 minutes global ischemia and 10 minutes reperfusion. Results: The diabetic heart was found to be resistant to IPC such that 3-IPC cycles, instead of the usual 1-IPC cycle, were required for cardioprotection. However, pretreatment with glimepiride lowered the threshold for IPC such that both 1 and 3 cycles of IPC elicited cardioprotection: chronic glimepiride treatment (IPC-1 31.9% + 3.8% and IPC-3 33.5% + 2.4% vs 43.9% + 1.4% control, P < .05; N > 6 per group); subacute glimepiride treatment (IPC-1 31.1% + 3.0% and IPC-3 29.3% + 3.3% vs 42.2% + 2.3% control, P < .05 N > 6 per group); and acute glimepiride treatment (IPC-1 28.2% + 3.7% and IPC-3 24.6% + 5.4% vs 41.9% + 5.4% control, P < .05; N > 6 per group). This effect of glimepiride was independent of changes in blood glucose. Conclusions: We report for the first time that glimepiride treatment facilitates the cardioprotective effect elicited by IPC in the diabetic heart.

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“…Several recent reports on survival of patients with chronic dialysis after CABG 4,[15][16][17][18][19][20][21][22][23][24][25][26] have demonstrates the operation can be performed with an acceptable mortality and morbidity for dialysis patients. 16,17,19,23,24,26 Herzog et al reported that dialysis patients have better long-term survival after CABG surgery than after percutaneous coronary intervention, especially diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…According to The United Kingdom Prospective Diabetes Study (2003), the largest-scale prospective study of diabetic nephropathy, when serum creatinine levels increase over 2.0 mg/dl, renal failure becomes end-stage, which requires dialysis within approximately 2.5 years and at which point the patient is likely to die within 3 years, 3 with the major cause of death being cardiovascular disease. 4,5 We mainly perform OPCAB in chronic dialysis patients and their intraoperative management has been established with an acceptable clinical outcome. In the present study, we investigated the preoperative and intraoperative confounding factors for chronic dialysis patients who underwent OPCAB and we assessed the impact of diabetic nephropathy and other possible risk factors on midterm survival after OPCAB in this population.…”

mentioning

confidence: 99%

Is Diabetic Nephropathy a Predicted Risk Factor? Kaplan-Meier and Multivariate Analysis of Confounding Risk Factors in Off-Pump Coronary Artery Bypass Grafting for Chronic Dialysis Patients

Oyamada

Kobayashi

Tagusari

et al. 2009

Circ J

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Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease

Abstract: Diabetes is an independent risk factor for early cardiac death only. Long-term survival in patients who survive the first 30 days is not statistically significantly different for diabetic and nondiabetic patients. In fact, the rates appear very similar.

Cited by 77 publications

References 34 publications

Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery

Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery

Glimepiride Treatment Facilitates Ischemic Preconditioning in the Diabetic Heart

Is Diabetic Nephropathy a Predicted Risk Factor? Kaplan-Meier and Multivariate Analysis of Confounding Risk Factors in Off-Pump Coronary Artery Bypass Grafting for Chronic Dialysis Patients

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