Diabetes increases some post-CABG risks, but not others

  • Brush JE & al.
  • Am J Cardiol
  • 7 Aug 2019

  • International Clinical Digest
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Takeaway

  • Diabetes mellitus (DM) does not significantly predict in-hospital mortality following coronary artery bypass grafting (CABG) or combined in-hospital postoperative events after adjusting for factors including surgical status, age, previous CABG, peripheral arterial disease, female sex, heart failure, lung disease, dialysis, ejection fraction, and previous myocardial infarction.
  • Diabetes does predict permanent stroke, surgical site infection, and new renal failure.

Why this matters

  • Previous study results were mixed on whether diabetes independently predicts CABG complications.

Study design

  • Single-centre study of 5013 post-CABG patients with diabetes and 6577 without; 32% with diabetes were insulin-treated.  
  • In-hospital postoperative events included permanent stroke, surgical site infection, pneumonia, prolonged ventilation, renal failure, gastroenterology events, multisystem failure, reoperation for bleeding, Afib, or cardiac arrest.
  • Permanent stroke defined as confirmed neurologic deficit unresolved within 24 hours, including ischemic, haemorrhagic, and embolic strokes.
  • Funding: EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Virginia.

Key results

  • In multivariable analysis, diabetes status did not significantly predict in-hospital mortality (P=.206) or combined in-hospital events (P=.545).
  • Compared with no diabetes, having diabetes was significantly associated with permanent stroke (unadjusted analysis, P<.001>
  • In multivariate analysis, insulin-treated diabetes significantly predicted surgical site infection (P=.036) and new renal failure (P<.001 vs no diabetes.>

Limitations

  • No information about diabetes type/duration, HbA1c levels.
  • Single centre.