Outcomes after surgical revascularization in diabetic patients Article Swipe

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Martín Misfeld , Sigrid Sandner , Etem Caliskan , Andreas Böning , José I. Aramendi , Sacha P. Salzberg , Yeong‐Hoon Choi , Louis P. Perrault , İlker Tekin , Gregorio Cuerpo , José López Menéndez , Luca Weltert , Alejandro Adsuar-Gómez , Matthias Thielmann , Giuseppe Filiberto Serraino , Gheorghe Doros , Michael A. Borger , Maximilian Y. Emmert , Sigrid Sandner , Daniel Zimpfer , Ulvi Cenk Oezpeker , Michael Grimm , Bernhard Winkler , Martin Grabenwöger , Michaele Andrä , Anas Aboud , Stephan Ensminger , Martín Misfeld , Michael A. Borger , Andreas Böning , Bernd Niemann , Tomáš Holubec , Arnaud Van Linden , Matthias Thielmann , D. Wendt , Assad Haneya , Katharina Huenges , J Böhm , Markus Krane , Etem Caliskan , Herko Grubitzsch , Farhad Bakthiary , Jörg Kempfert , Adam Penkalla , Bernhard C. Danner , Fawad A Jebran , Carina Benstoem , Andreas Goetzenich , Christian Stoppe , Elmar Kuhn , Yeong‐Hoon Choi , Oliver J. Liakopoulos , Stefan Brose , Klaus Matschke , Dave Veerasingam , Kishore Doddakula , Luca Weltert , Lorenzo Guerrieri Wolf , Giuseppe Filiberto Serraino , Pasquale Mastroroberto , Nicola Lamascese , M. Sella , José López Menéndez , Edmundo R Fajardo-Rodriguez , José I. Aramendi , Alejandro Crespo , Angel L Fernandez Gonález , Gregorio Cuerpo , Álvaro Pedraz , José María González‐Santos , Elena Arnáiz-García , Ignacio Muñoz Carvajal , Adrian J Fontaine , J.R. González Rodríguez , José Antonio Corrales Mera , Paloma Martı́nez , José Antonio Blázquez González , Juan-Carlos Tellez , Bella Ramirez , Alejandro Adsuar-Gómez , Jose M Borrego-Dominguez , Christian Muñoz-Guijosa , Sara Badía-Gamarra , Rafael Sádaba , Alicia Gainza , Manuel Castellá , Gregorio Laguna , Javier A Gualis , Enrico Ferrari , Stefanos Demertzis , Sacha P. Salzberg , Jürg Grünenfelder , Robert Bauernschmitt , İlker Tekin , Amal Bose , Nawwar Al‐Attar , George Gradinariu ·

YOU? · · 2024 · Open Access · · DOI: https://doi.org/10.1093/icvts/ivae014

OBJECTIVES Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG. METHODS The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE. RESULTS Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05–1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10–2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12–3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87–1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE. CONCLUSIONS In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM.

Related Topics

Medicine

Internal Medicine

Myocardial Infarction

Percutaneous Coronary Intervention

Endocrinology

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Medicine Mace Hazard ratio Internal medicine Propensity score matching Myocardial infarction Cardiology Revascularization Confidence interval Proportional hazards model Diabetes mellitus Percutaneous coronary intervention Surgery Endocrinology

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Title: Outcomes after surgical revascularization in diabetic patients

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Publication year: 2024

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Publication date: 2024-01-13

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Authors: Martín Misfeld, Sigrid Sandner, Etem Caliskan, Andreas Böning, José I. Aramendi, Sacha P. Salzberg, Yeong‐Hoon Choi, Louis P. Perrault, İlker Tekin, Gregorio Cuerpo, José López Menéndez, Luca Weltert, Alejandro Adsuar-Gómez, Matthias Thielmann, Giuseppe Filiberto Serraino, Gheorghe Doros, Michael A. Borger, Maximilian Y. Emmert, Sigrid Sandner, Daniel Zimpfer, Ulvi Cenk Oezpeker, Michael Grimm, Bernhard Winkler, Martin Grabenwöger, Michaele Andrä, Anas Aboud, Stephan Ensminger, Martín Misfeld, Michael A. Borger, Andreas Böning, Bernd Niemann, Tomáš Holubec, Arnaud Van Linden, Matthias Thielmann, D. Wendt, Assad Haneya, Katharina Huenges, J Böhm, Markus Krane, Etem Caliskan, Herko Grubitzsch, Farhad Bakthiary, Jörg Kempfert, Adam Penkalla, Bernhard C. Danner, Fawad A Jebran, Carina Benstoem, Andreas Goetzenich, Christian Stoppe, Elmar Kuhn, Yeong‐Hoon Choi, Oliver J. Liakopoulos, Stefan Brose, Klaus Matschke, Dave Veerasingam, Kishore Doddakula, Luca Weltert, Lorenzo Guerrieri Wolf, Giuseppe Filiberto Serraino, Pasquale Mastroroberto, Nicola Lamascese, M. Sella, José López Menéndez, Edmundo R Fajardo-Rodriguez, José I. Aramendi, Alejandro Crespo, Angel L Fernandez Gonález, Gregorio Cuerpo, Álvaro Pedraz, José María González‐Santos, Elena Arnáiz-García, Ignacio Muñoz Carvajal, Adrian J Fontaine, J.R. González Rodríguez, José Antonio Corrales Mera, Paloma Martı́nez, José Antonio Blázquez González, Juan-Carlos Tellez, Bella Ramirez, Alejandro Adsuar-Gómez, Jose M Borrego-Dominguez, Christian Muñoz-Guijosa, Sara Badía-Gamarra, Rafael Sádaba, Alicia Gainza, Manuel Castellá, Gregorio Laguna, Javier A Gualis, Enrico Ferrari, Stefanos Demertzis, Sacha P. Salzberg, Jürg Grünenfelder, Robert Bauernschmitt, İlker Tekin, Amal Bose, Nawwar Al‐Attar, George Gradinariu

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Concepts: Medicine, Mace, Hazard ratio, Internal medicine, Propensity score matching, Myocardial infarction, Cardiology, Revascularization, Confidence interval, Proportional hazards model, Diabetes mellitus, Percutaneous coronary intervention, Surgery, Endocrinology

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abstract_inverted_index.1.99	217
abstract_inverted_index.1072	118
abstract_inverted_index.1130	52
abstract_inverted_index.1402	57
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abstract_inverted_index.CABG	282
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abstract_inverted_index.each	121
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abstract_inverted_index.year	107
abstract_inverted_index.0.01]	209
abstract_inverted_index.0.23]	245
abstract_inverted_index.1.4%,	215
abstract_inverted_index.3.5%,	201
abstract_inverted_index.5.5%,	180
abstract_inverted_index.5.7%,	237
abstract_inverted_index.CABG.	45, 64
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abstract_inverted_index.[5.6%	199
abstract_inverted_index.[7.1%	235
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abstract_inverted_index.death	198
abstract_inverted_index.event	93
abstract_inverted_index.found	232
abstract_inverted_index.major	90
abstract_inverted_index.point	81
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abstract_inverted_index.ratio	182
abstract_inverted_index.score	124
abstract_inverted_index.study	31
abstract_inverted_index.used.	127
abstract_inverted_index.worse	19
abstract_inverted_index.year,	171
abstract_inverted_index.{7.9%	178
abstract_inverted_index.(CABG)	12
abstract_inverted_index.0.02].	223
abstract_inverted_index.0.02},	192
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abstract_inverted_index.artery	9
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abstract_inverted_index.grafts	71
abstract_inverted_index.hazard	181
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abstract_inverted_index.impact	36
abstract_inverted_index.regard	161
abstract_inverted_index.repeat	100
abstract_inverted_index.state,	252
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abstract_inverted_index.venous	68
abstract_inverted_index.≤50%	257
abstract_inverted_index.(44.6%)	54
abstract_inverted_index.(55.4%)	58
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abstract_inverted_index.Primary	79
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abstract_inverted_index.balance	110
abstract_inverted_index.between	111
abstract_inverted_index.cardiac	92
abstract_inverted_index.disease	261
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abstract_inverted_index.without	25, 60, 287
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abstract_inverted_index.European	48
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abstract_inverted_index.baseline	114
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abstract_inverted_index.ejection	255
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abstract_inverted_index.grafting	11
abstract_inverted_index.identify	136
abstract_inverted_index.included	51
abstract_inverted_index.interval	187
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abstract_inverted_index.matching	125
abstract_inverted_index.mellitus	5
abstract_inverted_index.outcomes	21, 42, 277
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abstract_inverted_index.infarction	104, 212
abstract_inverted_index.inhibitor.	78
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abstract_inverted_index.post-CABG.	108
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abstract_inverted_index.techniques	164
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abstract_inverted_index.endothelial	76
abstract_inverted_index.independent	137, 268
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abstract_inverted_index.0.87–1.74)	242
abstract_inverted_index.1.12–3.53)	220
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abstract_inverted_index.extracardiac	253
abstract_inverted_index.proportional	130
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abstract_inverted_index.1.10–2.36),	206
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abstract_inverted_index.arteriopathy,	254
abstract_inverted_index.statistically	228
abstract_inverted_index.cardiovascular	147
abstract_inverted_index.comorbidities.	156
abstract_inverted_index.characteristics	115
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