This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Leavitt, B. J. Search for Related Content PubMed PubMed Citation Articles by Leavitt, B. J.

(Circulation. 2004;110:II-41 – II-44.)
© 2004 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Effect of Diabetes and Associated Conditions on Long-Term Survival After Coronary Artery Bypass Graft Surgery

Bruce J. Leavitt, MD; Lynne Sheppard, RN MSN; Christopher Maloney, MD; Robert A. Clough, MD; John H. Braxton, MD; David C. Charlesworth, MD; Ronald M. Weintraub, MD; Felix Hernandez, MD; Elaine M. Olmstead; William C. Nugent, MD; Gerald T. O’Connor, PhD DSc; Cathy S. Ross, MS, for the Northern New England Cardiovascular Disease Study Group

From Fletcher Allen Heath Care (B.J.L.), Burlington, Vt; the Catholic Medical Center (L.S., C.M., D.C.C.), Manchester, NH; Eastern Maine Medical Center (R.A.C., F.H.), Bangor, Me; Maine Medical Center (J.H.B.), Portland, Me; Beth Israel Medical Center (R.M.W.), Boston, Mass; Dartmouth Medical School (E.M.O., G.T.O., C.S.R.), Hanover, NH; and Dartmouth-Hitchcock Medical Center (W.C.N.), Lebanon, NH.

Correspondence to Bruce J. Leavitt, MD, Fletcher Allen Health Care, 111 Colchester Avenue, Fletcher 454, Burlington, VT 05401-1473. E-mail bruce.leavitt{at}vtmednet.org

Background— The effects of diabetes on short-term results of coronary artery bypass graft (CABG) surgery are known, but less is known about the long-term effects of diabetes and diabetic-related sequelae for patients undergoing this surgery. We studied the 10-year survival of nondiabetic and diabetic patients undergoing CABG surgery.

Methods and Results— A prospective regional cohort study was conducted of 36 641 consecutive isolated CABG patients in northern New England from 1992 through 2001. Patient records were linked to the National Death Index to assess mortality. There were 154 140 person-years of follow-up and 5779 deaths. Kaplan–Meier techniques were used. Survival was stratified into three categories: no diabetes, diabetes without peripheral vascular disease and renal failure, and diabetes with peripheral vascular disease and/or renal failure. The overall annual incidence rate of death was 3.7 deaths per 100 person-years. Annual incidence rates for nondiabetic subjects and diabetic subjects were similar: 3.1 deaths per 100 person-years and 4.4 deaths per 100 person-years, respectively. The annual incidence rate for diabetic subjects with renal failure, peripheral vascular disease, or both was 9.4 deaths per 100 person-years. The log-rank test showed that the survival curves were significantly different (P<0.001).

Conclusion— Patients that have diabetes without the sequelae of renal failure and/or peripheral vascular disease have long-term survival similar to but slightly less than patients without diabetes who undergo CABG surgery. Survival of CABG surgery patients with diabetes is greatly affected by associated comorbidities of peripheral vascular disease and renal failure. This knowledge may help guide the patient as well as the cardiologist and cardiac surgeon in making appropriate decisions in these critically ill patients.

Key Words: diabetes mellitus • peripheral vascular disease • cardiopulmonary bypass • survival • renal failure • bypass • epidemiology

This article has been cited by other articles:

				D. C. Burgess, D. Hunt, L. Li, D. Zannino, E. Williamson, T. M.E. Davis, M. Laakso, Y. A. Kesaniemi, J. Zhang, R. W. Sy, et al. Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study Eur. Heart J., September 29, 2009; (2009) ehp377v1. [Abstract] [Full Text] [PDF]