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J Am Coll Cardiol. 2015 Apr 28;65(16):1644-1652. doi: 10.1016/j.jacc.2015.02.052.

Long-term prognosis in patients with type 1 and 2 diabetes mellitus after coronary artery bypass grafting.

Author information

1
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: martin.holzmann@karolinska.se.
2
Karolinska Institutet, Department of Clinical Sciences and Education, Sachs' Children's Hospital, Stockholm, Sweden.
3
Institute of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden; University of Gothenburg, Göteborg, Sweden.
4
Department of Cardiovascular Medicine, Danderyds Hospital, and Department of Internal Medicine, Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
5
Centre of Registers in Region Västra Götaland, Göteborg, Sweden.
6
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
7
Department of Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

Patients with diabetes mellitus (DM) have an increased risk of adverse outcomes after coronary artery bypass grafting (CABG). Previous studies have reported prognosis in relation to treatment with or without insulin, and not to the type of diabetes.

OBJECTIVES:

This study investigated long-term survival in patients with type 1 DM (T1DM) and type 2 DM (T2DM) following CABG.

METHODS:

We included all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent primary isolated CABG in Sweden during 2003 through 2013. We identified patients with T1DM or T2DM in the Swedish National Diabetes Register. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause mortality in patients with T1DM or T2DM.

RESULTS:

In total, 39,235 patients were included, of whom 725 (1.8%) had T1DM and 8,208 (21%) had T2DM. Patients with TDM1 were younger (59 vs. 67 years), had reduced kidney function (31% vs. 24%), and had peripheral vascular disease (21% vs. 11%) more often than patients with TDM2 or no diabetes. During a mean follow-up of 5.9±3.2 years (230,085 person-years), 6,765 (17%) patients died. Among patients with T1DM, 152 (21%) died, and among patients with T2DM, 1,549 (19%) died. Adjusted hazard ratio (95% confidence interval) for death in patients with T1DM and T2DM, compared with patients without diabetes, were 2.04 (1.72 to 2.42), and 1.11 (1.05 to 1.18), respectively.

CONCLUSIONS:

Patients with T1DM had more than double the long-term risk of death after CABG compared with patients without diabetes. The long-term risk of death in patients with T2DM was only slightly increased.

KEYWORDS:

isolated CABG; major adverse coronary event; prognosis; revascularization

PMID:
25908069
DOI:
10.1016/j.jacc.2015.02.052
[Indexed for MEDLINE]
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