Sean Gallagher1, Akhil Kapur1, Matthew J Lovell2, Dan A Jones1, Amy Kirkwood3, Sevda Hassan4, R Andrew Archbold2, Andrew Wragg2, Rakesh Uppal5, Muhammad M Yaqoob6. 1. Department of Cardiology, Barts Health NHS Trust, London, UK William Harvey Research Institute, Queen Mary and Westfield University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK. 2. Department of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK. 3. Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK. 4. Department of Cardiology, Barts Health NHS Trust, London, UK. 5. William Harvey Research Institute, Queen Mary and Westfield University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK Department of Cardiothoracic Surgery, Barts Health NHS Trust, London, UK. 6. William Harvey Research Institute, Queen Mary and Westfield University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK Department of Nephrology, Barts Health NHS Trust, London, UK m.m.yaqoob@qmul.ac.uk.
Abstract
OBJECTIVES: Diabetes mellitus (DM) and renal impairment (RI) are both independent predictors of mortality after coronary artery bypass graft surgery (CABG). The two conditions often coexist, yet the impact on long-term prognosis after CABG of each factor relative to the other and the two in combination is uncertain. METHODS: We undertook a prospective cohort study of 4869 patients who underwent CABG between 2003 and 2007. The cohort was divided into four groups according to preoperative diabetic status and renal function: patients without either DM or RI (reference group), patients with DM alone, patients with RI alone and patients with both DM and RI. Clinical outcomes were compared between groups. Patients receiving renal replacement therapy were excluded. The primary outcome was 5-year all-cause mortality. RESULTS: The crude 5-year all-cause mortality rate was 9.0% for patients in the reference group, 11.1% for patients with DM alone, 20.3% for patients with RI alone and 28.5% for patients with both DM and RI (P < 0.0001). Five-year survival adjusted for potential confounding factors was significantly worse for patients with DM (hazard ratio (HR) 1.30; 95% confidence interval (CI) 1.06-1.59), patients with RI (HR 1.32; 95% CI 1.08-1.61) and patients with both DM and RI (HR 2.04; 95% CI 1.65-2.53) when compared with patients with neither condition. CONCLUSIONS: Preoperative DM and RI were important predictors of 5-year mortality after CABG. Patients with RI alone had a higher mortality rate than patients with DM alone, but this difference was largely accounted for by age and other comorbidities. The combination of DM and RI doubled the 5-year mortality rate after CABG independently of potential confounding factors.
OBJECTIVES:Diabetes mellitus (DM) and renal impairment (RI) are both independent predictors of mortality after coronary artery bypass graft surgery (CABG). The two conditions often coexist, yet the impact on long-term prognosis after CABG of each factor relative to the other and the two in combination is uncertain. METHODS: We undertook a prospective cohort study of 4869 patients who underwent CABG between 2003 and 2007. The cohort was divided into four groups according to preoperative diabetic status and renal function: patients without either DM or RI (reference group), patients with DM alone, patients with RI alone and patients with both DM and RI. Clinical outcomes were compared between groups. Patients receiving renal replacement therapy were excluded. The primary outcome was 5-year all-cause mortality. RESULTS: The crude 5-year all-cause mortality rate was 9.0% for patients in the reference group, 11.1% for patients with DM alone, 20.3% for patients with RI alone and 28.5% for patients with both DM and RI (P < 0.0001). Five-year survival adjusted for potential confounding factors was significantly worse for patients with DM (hazard ratio (HR) 1.30; 95% confidence interval (CI) 1.06-1.59), patients with RI (HR 1.32; 95% CI 1.08-1.61) and patients with both DM and RI (HR 2.04; 95% CI 1.65-2.53) when compared with patients with neither condition. CONCLUSIONS: Preoperative DM and RI were important predictors of 5-year mortality after CABG. Patients with RI alone had a higher mortality rate than patients with DM alone, but this difference was largely accounted for by age and other comorbidities. The combination of DM and RI doubled the 5-year mortality rate after CABG independently of potential confounding factors.
Authors: Ali F AbuRahma; Mohit Srivastava; Patrick A Stone; Benny Chong; Will Jackson; L Scott Dean; Albeir Y Mousa Journal: J Vasc Surg Date: 2014-12-09 Impact factor: 4.268