Off-pump Coronary Artery Bypass Surgery with Multiple Arterial Grafts in Diabetic Patients: Short and Long-term Results

pp. 505-512

Abstract

Introduction
Diabetes mellitus has been identified as a strong independent predictor of cardiovascular disease onset and progression and acknowledged as a mortality risk factor after coronary artery surgery. Off-pump coronary artery bypass grafting has been established as an efficient alternative for coronary revascularization comparable to the conventional technique, with results evidencing a reduction in procedure morbidity and, in high risk patients, lower postoperative mortality.

Objective

The aims of this study were to compare short and long-term postoperative results of off-pump coronary artery revascularization revascularization surgerywith multiple arterial grafts in patients with or without diabetes mellitus and to determine if postoperative hyperglycemia is an independent predictor of early morbidity and mortality.

Methods
Off-pump coronary artery revascularization surgery with multiple arterial grafts was consecutively performed on 1002 patients between January 2004 and December 2008. The population was divided in diabetes mellitus (n: 234) and non-diabetes mellitus (n: 768) patients. Post-operative complications were analyzed and independent predictors of in-hospital mortality were identified. The average follow-up period of 1038 ± 517 days was completed by 95.7% of patients.

Results
Diabetes mellitus patients had lower cardiac output (p = 0.005), atrial fibrillation (p = 0.005) and deep sternal wound infection (p = 0.005). Age (OR = 1.11), non-elective surgery (OR = 5.88) and blood glucose level > 200 mg/dL (OR= 6.9) were significant predictors of in-hospital mortality. Five-year survival was lower in diabetes mellitus patients (p = 0.01). Diabetes mellitus (HR = 2.1), age (HR = 1.06), left ventricular ejection fraction < 40% (HR = 2.45) and postoperative creatinine > 1.6 mg/dL (HR =2.46) were significant predictors of decreased long-term survival.

Conclusions
Diabetes mellitus and non-diabetes mellitus patients had similar in-hospital mortality rates. Postoperative hyperglycemia was a predictor of greater in-hospital mortality. Diabetes mellitus and creatinine > 1.6 mg/dL were independent predictors of decreased long-term survival.