The effect of diabetes on long-term outcomes in patients following coronary artery bypass grafting.

IF 3 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS European Journal of Cardio-Thoracic Surgery Pub Date : 2025-02-04 DOI:10.1093/ejcts/ezaf024

Fabio Barili, Nicolò Vitale, Paola D'Errigo, Francesco Porcedda, Francesco Pollari, Giovanni Baglio, Andrea Daprati, Gabriella Badoni, Giorgia Duranti, Francesco Donatelli, Alessandro Parolari, Stefano Rosato

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Abstract

Objectives: Diabetes mellitus is a risk factor for coronary artery disease, but its role following coronary artery bypass grafting (CABG) is still unclear and few data on long-term outcomes are available. This study aimed to evaluate the impact of diabetes on long-term outcomes after CABG.

Methods: The PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgerY) project is an observational cohort study merging 2 prospective multicentre studies on isolated CABG. Follow-up information was obtained through administrative databases and was truncated 10 years after the intervention. Baseline differences between patients with and without diabetes were balanced with inverse probability of treatment weighting.

Results: The cohort consisted of 10 989 patients with complete follow-up information who underwent isolated CABG (diabetes 32.3%). Diabetes did not affect short-term mortality [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.73-1.10] and repeat revascularization (OR 0.79, 95% CI 0.42-1.49), while it is related to lower incidence of 30-day major adverse cardiac and cerebrovascular events (OR 0.67, 95% CI 0.60-0.76), acute myocardial infarction (OR 0.60, 95% CI 0.51-0.70) and stroke (OR 0.47, 95% CI 0.28-0.77). Diabetic patients had a higher long-term risk for major adverse cardiac and cerebrovascular event [weighted hazard ratio (HR) 1.31, 95% CI 1.26-1.37], mortality (HR 1.45, 95% CI 1.37-1.53), as well as stroke (HR 1.38, 95% CI 1.25-1.53) and myocardial infarction (HR 1.39, 95% CI 1.26-1. 53). Diabetes had not been associated with an increased incidence of repeated revascularization up to 10 years (HR 1.04, 95% CI 0.96-1.12).

Conclusions: Diabetic patients had worse long-term outcomes. Diabetes may have a greater negative impact on micro-vasculopathy than grafts, as evidenced by the increased long-term incidence of myocardial infarction without affecting myocardial revascularization.

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糖尿病对冠状动脉旁路移植术后患者长期疗效的影响。

目的：糖尿病是冠状动脉疾病的危险因素，但其在冠状动脉搭桥后的作用尚不清楚，而且很少有关于长期结果的数据。本研究旨在评估糖尿病对冠脉搭桥术后长期预后的影响。方法：PRIORITY项目是一项观察性队列研究，合并了两项前瞻性多中心研究。通过管理数据库获得随访信息，并在干预后10年进行截断。糖尿病患者和非糖尿病患者之间的基线差异与治疗加权的逆概率相平衡。结果：该队列包括10,989例接受孤立CABG的患者，随访信息完整（糖尿病32.3%）。糖尿病不影响短期死亡率（OR 0.90, 95% CI 0.73-1.10）和重复血运重建（OR 0.79, 95% CI 0.42-1.49），但与30天MACCE （OR 0.67, 95% CI 0.60-0.76）、AMI （OR 0.60, 95% CI 0.51-0.70）和卒中（OR 0.47, 95% CI 0.28-0.77）的发生率降低有关。糖尿病患者发生MACCE（加权HR 1.31, 95% CI 1.26-1.37）、死亡率（HR 1.45, 95% CI 1.37-1.53）、卒中（HR 1.38, 95% CI 1.25-1.53）和心肌梗死（HR 1.39, 95% CI 1.26-1）的长期风险较高。53)。糖尿病与10年内反复血运重建的发生率增加无关（HR 1.04, 95%IC 0.96-1.12）。结论：糖尿病患者的长期预后较差。糖尿病可能比移植对微血管病变有更大的负面影响，这可以从心肌梗死的长期发生率增加而不影响心肌血运重建中得到证明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Cardio-Thoracic Surgery 医学-呼吸系统

CiteScore

5.60

自引率

11.80%

发文量

564

审稿时长

2 months

期刊介绍： The primary aim of the European Journal of Cardio-Thoracic Surgery is to provide a medium for the publication of high-quality original scientific reports documenting progress in cardiac and thoracic surgery. The journal publishes reports of significant clinical and experimental advances related to surgery of the heart, the great vessels and the chest. The European Journal of Cardio-Thoracic Surgery is an international journal and accepts submissions from all regions. The journal is supported by a number of leading European societies.