Long-term survival and prognostic implications of Chinese type 2 diabetic patients with coronary artery disease after coronary artery bypass grafting

Ming C Hsiung, Tao-Hsin Tung, Chung-Yi Chang, Yi-Cheng Chuang, Kuo-Chen Lee, Sung-How Sue, Yi-Pen Chou, Richard Hsiung, Chien-Ming Huang, Chang-Chyi Lin, Wei-Hsian Yin, Mason S Young, Jeng Wei
DOI: 10.4236/health.2009.13023                

Abstract

This study was conducted to determine the sur-vival rates of type 2 diabetic patients after coro-nary artery bypass grafting (CABG) surgery, and the prognostic factors related to all-cause mor-tality during a 7-year follow-up. The medical re-cords of 816 type 2 diabetic patients who un-derwent primary, isolated CABG surgery during 1997-2003 were studied. The Kaplan-Meier me- thod and Cox regression were used to estimate survival and the independence of prognostic factors associated with all-cause mortality. One hundred and five out of 816 patients expired during the 7-year period. The overall survival rate was 83.5% (95%CI: 78.7-88.3%). Associated prog- nostic factors varied by gender. For males, but not for females, smoking (RR=3.44, 95%CI: 1.01- 11.70), myocardial infarction (RR=4.77, 95% CI: 1.23-18.86), respiratory failure (RR=4.21, 95% CI: 1.48-7.99), cardiogenic shock (RR=12.58, 95% CI: 3.25-20.77), and congestive heart failure (RR= 3.77, 95%CI: 1.10-13.45) were significantly related to all-cause mortality. Older age at sur-gery (RR= 1.15, 95%CI: 1.04-1.27), emergent op-eration (RR= 21.29, 95%CI: 10.03-39.43), pul-monary ede-ma (RR=7.72, 95%CI: 1.89-15.59), and days of ICU stay (RR=1.05, 95%CI: 1.02-1.09) were significant- ly related to all-cause mortality in females only. In conclusion, several gen-der-related differences were noted pertaining to all-cause mortality and its relationship to smok- ing, myocardial infarction, respiratory failure, cardiogenic shock, congestive heart failure, older age at surgery, emergent operation, pul-monary edema, and days of ICU stay.

Keywords

Coronary Artery Bypass Grafting; Gender Difference; Prognostic Factors; Survival; Type 2 Diabetes

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	T. Hakala, O. Pitkanen, P. Halonen, et al., (2005) Early and late outcome after coronary bypass surgery in diabetic patients. Scand Cardiovasc J, 39(3), 177-181.
[2]	A. M. Calafiore, M. Di Mauro, G. Di Giammarco, et al., (2003) Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel dis-ease. J Thorac Cardiovasc Surg, 125(1), 144-154.
[3]	V. H. Thourani, W. S. Weintraub, B. Stein, et al., (1999) Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg, 67(4), 1045-1052.
[4]	T. Ono, J. Kobayashi, Y. Sasako, et al., (2002) The impact of diabetic retinopathy on long-term outcome following coronary artery bypass graft surgery, J Am Coll Cardiol, 40(3), 428-436.
[5]	J. D. Lin, W. B. Shieh, M. J. Huang, et al., (1993) Diabetes mellitus and hypertension based on the family history and 2-h postprandial blood sugar in the Ann-Lo district (Northern Taiwan). Diabetes Res Clin Pract, 20(1), 75-85.
[6]	C. L. Li, S. T. Tsai, P. Chou, et al., (1999) Comparison of the results between two diagnostic criteria by ADA and WHO among subjects with FPG 5.6-7.8 mmol/l in Kin-Hu and Kin-Chen, Kinmen, 1991-94. Diabetes Res Clin Pract, 45(1), 51-59.
[7]	P. Chou, M. J. Liao, H. S. Kuo. et al., (1994) A population survey on the prevalence of diabetes in Kin-Hu, Kinmen. Diabetes Care, 17(9), 1055-1058.
[8]	P. Chou, C. L. Li, H. S. Kuo, et al., (1997) Comparison of the prevalence of two diabetes surveys between 1987-88 and 1991-92 in Pu-Li, Taiwan. Diabetes Res Clin Pract, 38(1), 61-67.
[9]	H. D. Chen, C. K. Shaw, W. P. Tseng, et al., (1997) Prevalence of diabetes mellitus and impaired glucose tol-erance in Aborigines and Chinese in eastern Taiwan. Diabetes Res Clin Pract, 38(3), 199-205.
[10]	F. H. Lu, Y. C. Yang, J. S. Wu, et al., (1998) A popula-tion-based study of the prevalence and associated factors of diabetes mellitus in southern Taiwan. Diabetes Med, 15(7), 564-572.
[11]	K. T. Chen, C. J. Chen, E. W. Gregg, et al., (1999) High prevalence of impaired fasting glucose and type 2 diabetes mellitus in Penghu Islets, Taiwan: evidence of a rapidly emerging epidemic? Diabetes Res Clin Pract, 44(1), 59-69.
[12]	World Health Organization, (1999) Definition, diagnosis and classification of diabetes mellitus and its complica-tions: Report of a WHO Consultation, Part 1, Diagnosis and classification of diabetes mellitus, Geneva, World Health Organization.
[13]	Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, (1997) The sixth report of the joint national committee on pre-vention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med, 157(21), 2413-2446.
[14]	C. M. Liu, T. H. Tung, J. H. Liu, et al., (2005) A commu-nity-based epidemiological study of elevated serum alanine aminotransferase levels in Kinmen, Taiwan. World J Gastroenterol, 11(11), 1616-1622.
[15]	C. H. Huang, S. T. Lai, and Z. C. Weng, (2001) Risk factors for mortality in primary isolated coronary artery bypass grafting surgery. J Formos Med Assoc, 100(5), 299-303.
[16]	C. H. Huang, C. P. Hsu, S. T. Lai, et al., (2004) Operative results of coronary artery bypass grafting in women. Int J Cardial, 94(1), 61-66.
[17]	M. C. Hsiung, J. Wei, C. Y. Chang, et al., (2006) Long- term survival and prognostic implications after coronary artery bypass grafting in Chinese patients with coronary artery disease. Acta Cardiol, 61(5), 519-524.
[18]	W. Whang and J. T. Bigger, (2000) Diabetes and outcomes of coronary artery bypass graft surgery in patients with se-vere left ventricular dysfunction: results from the CABG Patch trial database, The CABG Pateh Trial Investigators and Coordinators. J Am Coll Cardiol, 36(4), 1166-1172.
[19]	C. Rajakaruna, C. A. Rogers, C. Suranimala, et al., (2006) The effect of diabetes mellitus on patients undergoing coronary surgery: A risk-adjusted analysis. J Thorac Car-diovasc Surg, 132(4), 802-810.
[20]	R. Lorusso, S. Pentiricci, R. Raddino, et al., (2003) In-fluence of type 2 diabetes on functional and structural properties of coronary artery bypass conduits. Diabetes, 52(11), 2814-2820.
[21]	J. G. Motwani and E. J. Topol, (1998) Aortocoronary saphenous cein graft disease: Pathogenesis, predisposition and prevention. Circulation, 97(9), 916-931.
[22]	G. Brandrup-Wognsen, H. Berggren, M. Hartford, et al., (1996) Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting. Eur Heart J, 17(9), 1426-1431.
[23]	I. K. Toumpoulis, C. E. Anagnostopoulos, S. K. Balaram, et al., (2006) Assessment of independent predictors for long-term mortality between women and men after coro-nary artery bypass grafting: Are women different from men? J Thorac Cardiovasc Surg, 131(2), 343-351.
[24]	C. D. Naylor and C. M. Levinton, (1993) Sex-related difference in coronary revascularization practices: the perspective from a Canadian queen management project. Can Med Assoc J, 149(7), 965-973.
[25]	M. R. Williams, A. F. Choudhri, D. L. Morales, et al., (2000) Gender differences in patients undergoing coro-nary artery bypass surgery, from a mandatory statewide database. J Gend-Specif Med, 3(1), 41-48.