Role of CABG in the management of obstructive coronary arterial disease in patients with diabetes mellitus

SUMMARY Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial and requires a multidisciplinary team approach (‘heart team’). Large scale clinical trials have shown that for many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy (OMT). PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with OMT. Randomized trials comparing multivessel PCI to coronary artery bypass grafting (CABG) have consistently demonstrated the superiority of CABG in reducing mortality, myocardial infarctions and need for repeat revascularizations.

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“…Proximal coronary arterial stents however, bare metal and drug-eluting, cannot protect against new disease. 93 …”

Section: Coronary Revascularization In Patients With Dmmentioning

confidence: 99%

Coronary Artery Disease and Diabetes Mellitus

2014

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“…10 Diabetes may lead to unfavorable clinical outcomes and increased risk of postprocedural complications. 22 High rates of repeat revascularizations are observed in diabetics following percutaneous coronary interventions. Even though less pronounced, the risk of late or repeat coronary revascularizations is also seen in diabetics after CABG, especially if insulin treated.…”

Section: Discussionmentioning

confidence: 99%

Impact of Modifiable Risk Factors on Long-Term Outcomes after Coronary Artery Bypass Surgery

Leviner

Zafrir

Jaffe

et al. 2020

Thorac Cardiovasc Surg

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Background Risk factors control and secondary prevention measures are often reported to be suboptimal in patients undergoing coronary artery bypass grafting (CABG) and may lead to worse clinical outcomes. We aimed to examine potentially modifiable risk factors in patients undergoing CABG and investigate their association with long-term coronary events. Methods Cardiovascular risk factors were recorded preoperatively in the setting of a cardiac catheterization laboratory and were analyzed in relation to long-term coronary events, defined as acute coronary syndrome (ACS) or revascularization after CABG. Results Study population included 1,125 patients undergoing CABG without previous revascularization. Modifiable risk factors included hypertension (71%), hyperlipidemia (67%), diabetes (42%), obesity (28%), and smoking (21%). Only 8% did not have any of the five risk factors. During the mean follow-up of 93 ± 52 months after CABG, 179 patients (16%) experienced a coronary event. Incidence rates were higher in patients with than without the presence of each of the modifiable risk factors, except obesity. Active smoking (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: (1.07–2.13); p = 0.020), presence of diabetes (HR: 1.61; 95% CI: 1.18–2.18; p = 0.002), and hyperlipidemia (HR: 2.13; 95% CI: 1.45–3.14; p < 0.001) were independent predictors of future coronary events after CABG; they also displayed a progressive stepwise increment in the risk of long-term coronary events when cumulatively present. Conclusions In patients undergoing CABG, diabetes, hyperlipidemia, and smoking, as documented preoperatively, were potentially modifiable risk factors that were independently and cumulatively associated with long-term risk of ACS or coronary revascularization, highlighting the importance of early identification and risk factors control for improving cardiovascular health after CABG.

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“…Ástaeðurnar eru aðallega aukið algengi sykursýki en einnig góður árangur þessara aðgerða hjá sykursjúkum. 15,16 Algengi sykursýki af tegund 2 er að aukast víðast hvar í heiminum og hér á landi jókst það á 30 ára tímabili úr 3,3% í 6,3% hjá karlmönnum og úr 1,7% í 3% hjá konum. 17 Þó er algengi sykursýki af tegund 2 mun laegra hér landi en í Bandaríkjunum og Þýskalandi þar sem það er þrefalt haerra.…”

Section: áGripunclassified