2015 Young Surgeon's Award Winner: Long-term Prognosis in Patients with Diabetes Mellitus after Coronary Artery Bypass Grafting: A Propensity-Matched Study.
- Author:
Philip Yk PANG
1
;
Yeong Phang LIM
;
Kim Kiat ONG
;
Yeow Leng CHUA
;
Yoong Kong SIN
Author Information
- Publication Type:Journal Article
- MeSH: Age Factors; Aged; Awards and Prizes; Case-Control Studies; Comorbidity; Coronary Artery Bypass; Coronary Artery Disease; epidemiology; surgery; Diabetes Mellitus; epidemiology; Dyslipidemias; epidemiology; Female; Follow-Up Studies; Hospital Mortality; Humans; Hypertension; epidemiology; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; epidemiology; Prognosis; Propensity Score; Proportional Hazards Models; Retrospective Studies; Sex Factors; Singapore; epidemiology; Stroke Volume
- From:Annals of the Academy of Medicine, Singapore 2016;45(3):83-90
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONWe aimed to determine the impact of diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease.
MATERIALS AND METHODSA retrospective review was conducted for 5720 consecutive patients who underwent isolated first CABG between 1982 and 1999. Outcomes were reviewed to include in-hospital mortality and long-term survival. Mean follow-up was 13.0 ± 5.8 years. To obtain comparable subgroups, 561 diabetic patients were matched with 561 non-diabetic controls based on estimated propensity scores.
RESULTSMean age was 59.3 ± 9.1 years with 4373 (76.5%) males. Amongst 5720 patients, 1977 (34.6%) had DM. Hypertension and dyslipidaemia were the most common cardiovascular comorbidities, present in 2920 (51.0%) and 2664 patients (46.6%) respectively. Emergency surgery was performed in 563 patients (9.8%). In-patient mortality occurred in 115 patients (2.0%), 48 (2.4%) in the DM group and 67 (1.8%) in the non-DM group, (P = 0.102). In the unmatched cohort, overall 20-year survival rates were 30.9 ± 1.6% in diabetics and 49.2 ± 1.0% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 56.0 ± 2.0% in diabetics and 68.4 ± 1.0% in non-diabetics (P <0.001). In the propensity-matched group, overall 20-year survival rates were 35.4 ± 2.5% in diabetics and 48.9 ± 2.9% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 57.8 ± 3.0% in diabetics and 70.2 ± 2.9% in non-diabetics (P = 0.001). Multivariable Cox regression analysis identified age (hazard ratio (HR): 1.03/year), female gender (HR: 1.43), DM (HR: 1.51), previous myocardial infarction (HR: 1.54) and left ventricular ejection fraction (LVEF) <35% (HR: 2.60) as independent factors influencing long-term cardiac mortality.
CONCLUSIONDespite low operative mortality, long-term survival and freedom from cardiac death are significantly lower in patients with DM compared to non-diabetics. Aggressive treatment of DM, cardiovascular comorbidities and smoking cessation are essential to improve long-term survival in diabetic patients.
