[Influence of diabetes mellitus and complications on long-term outcome of coronary artery bypass surgery].

The influence of diabetes mellitus and complications on the long-term outcome of coronary artery bypass graft surgery (CABG) was investigated in 192 consecutive patients who underwent elective CABG between January 1992 and March 1996. Of these, 102 patients were diabetic and 90 were nondiabetic. Preoperative and postoperative left ventricular ejection fraction, number of grafts, use of arterial conduit, and frequency of perioperative infarction were all similar in the 2 groups. During a mean follow-up of 3.2 years, diabetics showed higher cardiac mortality than nondiabetics (15% vs 3%, p = 0.01). Cardiac event-free survival was also low in diabetics, and this difference increased throughout the period (91% vs 99% at 2 years, 74% vs 90% at 4 years in diabetics and nondiabetics, respectively, by Kaplan-Meier analysis, p = 0.008). Multivariate Cox regression analysis revealed postoperative low ejection fraction and diabetes mellitus as independent predictors of late cardiac death. Major causes of cardiac death in diabetics were sudden death, pump failure and acute myocardial infarction. Additionally, subgroup analysis in diabetics using the Cox regression model identified postoperative low ejection fraction, female gender and diabetic nephropathy as independent predictors of late cardiac death. Thus, patients with diabetes have a worse clinical outcome after CABG, especially when associated with low ejection fraction, female gender and diabetic nephropathy. Intensive management of heart failure, prevention of myocardial infarction and specific strategy for female patients are all essential to improve the long-term outcome of diabetics after CABG.