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

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• 作者：Kenji Minakata ; MD ; PhD^a ; Ko Bando ; MD ; PhD^b ; Shuichiro Takanashi ; MD ; PhD^c ; Hiroaki Konishi ; MD ; PhD^d ; Yoshihiro Miyamoto ; MD ; PhD^e ; Kenji Ueshima ; MD ; PhD ; FJCC^a ; Tosiya Sato ; PhD^f ; Yuichi Ueda ; MD ; PhD^g ; Yutaka Okita ; MD ; PhD^h ; Izuru Masuda ; MD ; PhDⁱ ; Hitoshi Okabayashi ; MD ; PhD^j ; Hitoshi Yaku ; MD ; PhD ; FJCC^k ; Shinji Yasuno ; MD ; PhD^a ; Hiroyuki Muranaka ; MD ; PhD^a ; Masato Kasahara ; MD ; PhD^a ; Shigeki Miyata ; MD ; PhD^e ; Yoshitaka Okamura ; MD ; PhD^l ; Michihiro Nasu ; MD ; PhD^m ; Kazuo Tanemoto ; MD ; PhDⁿ ; Koichi Arinaga ; MD ; PhD^o ; Yosuke Hisashi ; MD^p ; Ryuzo Sakata ; MD ; PhD ; FJCC^a ; ^{sakatar@kuhp.kyoto-u.ac.jp} ; the JMAP Study Investigators
• 关键词：Complication ; Coronary artery bypass grafting ; Diabetes mellitus ; Infection ; Mortality ; Renal insufficiency
• 刊名：Journal of Cardiology
• 出版年：2012
• 期刊代码：P90_09145087
• 类别：med
• 出版时间：May, 2012
• 卷：59
• 期：3
• 页码：275-284
• 文件大小：304 K

摘要

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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: 68.5 years). The definitions of DM were all patients admitted with diagnosis of DM and preoperative glycated hemoglobin (Hb) A1c 鈮?#xA0;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 146 mg/dl, 172 mg/dl, and 168 mg/dl in the DM group, and 103 mg/dl, 140 mg/dl, and 136 mg/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.