Influence of Diabetes Mellitus and the Quality of Coronary Beds in the Long-term Outcome after Coronary Surgery. SEGUIR Study

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Abstract

Work Objective

To analyze the long-term outcome of diabetic patients (DM) after myocardial revascularization surgery (MRS) as related to the quality of coronary beds. 

Research Design and Methods

From a total of 1020 patients operated between January 1997 and December 2001, a 4-year  follow-up was performed in 957, analyzing the differences between DM and non-DM patients. 

Results

Mean age was 63.3 ± 9.8 years, 87% were male and 210 (21.9%) were diabetics. Mean follow-up time was 771 days (1-1844). In-hospital mortality rate was 4.2% (9/210) in the DM group and 2.5% (21/810) in the non-DM group. DM patients showed a greater incidence of: a) severe ventricular dysfunction (15.2% vs 10.4%, p=0.05); b) previous MRS (12.8% vs. 6.4%, p= 0.002); c) COPD (6.19% vs 2.01, p<0.001). Poor quality of coronary vessels was significantly more frequent in DM than in non-DM patients (52% vs 43%, p 0.0075, OR: 1.47, 95% CI: 1.11-1.96). Mid-term survival rate was different between groups: 89.7% and 77.5% in DM, and 94.6% and 89.7% in non-DM at 1 and 4 years respectively (p=0.002). Poor coronary beds was an independent predictor for in-hospital mortality (p<0.001, OR: 1.4, 95% CI: 0.5-2.2) and readmission in this mid-term follow-up (p=0.02, HR: 1.89, 95% CI: 1.09-3.28).

Conclusions

In MRS patients, diabetics showed a shorter long-term survival than non-diabetics. Patients with poor coronary beds showed greater in-hospital mortality and greater incidence of hospital readmission during  this mid-term follow-up.