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Impact of diabetes mellitus on outcomes in Japanese patients undergoing coronary artery bypass grafting

2012; Elsevier BV; Volume: 59; Issue: 3 Linguagem: Inglês

10.1016/j.jjcc.2011.12.009

1876-4738

Kenji Minakata, Ko Bando, Shuichiro Takanashi, Hiroaki Konishi, Yoshihiro Miyamoto, Kenji Ueshima, Tosiya Sato, Yuichi Ueda, Yutaka Okita, Izuru Masuda, Hitoshi Okabayashi, Hitoshi Yaku, Shinji Yasuno, Hiroyuki Muranaka, Masato Kasahara, Shigeki Miyata, Yoshitaka Okamura, Michihiro Nasu, Kazuo Tanemoto, Koichi Arinaga, Yosuke Hisashi, Ryuzo Sakata,

Cardiac and Coronary Surgery Techniques

Summary Background and purpose There have been no large-scale studies on the impact of diabetes mellitus (DM) on outcomes in Japanese patients undergoing coronary artery bypass grafting (CABG). Methods and subjects A multi-institutional retrospective cohort study was conducted in 14 Japanese centers. All adult patients who underwent isolated CABG from 2007 to 2008 were included ( n =1522, mean age: 68.5years). The definitions of DM were all patients admitted with diagnosis of DM and preoperative glycated hemoglobin (Hb) A1c≥6.5%. Univariate and multivariate analyses were performed to identify the risk of morbidity and mortality. Results There were 849 DM and 572 non-DM patients. Preoperative mean HbA1c were 7.1% in the DM group and 5.7% in the non-DM group ( p <0.0001). Preoperative, intraoperative, and 3-day average postoperative blood glucose (BG) were 146mg/dl, 172mg/dl, and 168mg/dl in the DM group, and 103mg/dl, 140mg/dl, and 136mg/dl in the non-DM group (all p <0.0001). Although there were no significant differences in postoperative cardiovascular events, the incidence of infection was significantly higher in the DM group than in the non-DM group (9.2% vs 6.1%, p =0.036) on the univariate analysis. The all-cause death was also relatively higher in the DM group than in the non-DM group (2.1% vs 1.1%, p =0.12), and this was likely related to infection. Conclusion DM patients had worse perioperative BG control, higher incidence of infection, and higher mortality than non-DM patients. These results indicate that perioperative BG control guidelines should be standardized to obtain better surgical outcomes in Japanese DM patients.