Outcomes after surgical revascularization in diabetic patients
Authors: Misfeld Martin , Sandner Sigrid , Caliskan Etem , Böning Andreas , Aramendi Jose , Salzberg Sacha P , Choi Yeong-Hoon , Perrault Louis P , Tekin Ilker , Cuerpo Gregorio P , Lopez-Menendez Jose , Weltert Luca P , Adsuar-Gomez Alejandro , Thielmann Matthias , Serraino Giuseppe F , Doros Gheorghe , Borger Michael A , Emmert Maximilian Y ,   European DuraGraft Registry investigators, Sandner Sigrid , Zimpfer Daniel , Oezpeker Ulvi Cenk , Grimm Michael , Winkler Bernhard , Grabenwöger Martin , Andrä Michaele , Aboud Anas , Ensminger Stephan , Misfeld Martin , Borger Michael A , Böning Andreas , Niemann Bernd , Holubec Tomas , Van Linden Arnaud , Thielmann Matthias , Wendt Daniel , Haneya Assad , Huenges Katharina , Böhm Johannes , Krane Markus , Caliskan Etem , Grubitzsch Herko , Bakthiary Farhad , Kempfert Jörg , Penkalla Adam J , Danner Bernhard C , Jebran Fawad A , Benstoem Carina , Goetzenich Andreas , Stoppe Christian , Kuhn Elmar W , Choi Yeong-Hoon , Liakopoulos Oliver J , Brose Stefan , Matschke Klaus , Veerasingam Dave , Doddakula Kishore , Weltert Luca P , Wolf Lorenzo Guerrieri , Serraino Giuseppe Filiberto , Mastroroberto Pasquale , Lamascese Nicola , Sella Massimo , Lopez-Menendez Jose , Fajardo-Rodriguez Edmundo R , Aramendi Jose I , Crespo Alejandro , Gonález Angel L Fernandez , Cuerpo Gregorio P , Pedraz Alvaro , González-Santos José M , Arnáiz-García Elena , Carvajal Ignacio Muñoz , Fontaine Adrian J , Rodríguez José Ramón González , Mera José Antonio Corrales , Martinez Paloma , Blazquez Jose Antonio , Tellez Juan-Carlos , Ramirez Bella , Adsuar-Gomez Alejandro , Borrego-Dominguez Jose M , Muñoz-Guijosa Christian , Badía-Gamarra Sara , Sádaba Rafael , Gainza Alicia , Castellá Manuel , Laguna Gregorio , Gualis Javier A , Ferrari Enrico , Demertzis Stefanos , Salzberg Sacha , Grünenfelder Jürg , Bauernschmitt Robert , Tekin Ilker , Bose Amal K , Al-Attar Nawwar , Gradinariu George 
Published: January 2024

Abstract

OBJECTIVES
Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG.

METHODS
The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE.

RESULTS
Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05–1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10–2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12–3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87–1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE.

CONCLUSIONS
In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM.