The Comparison
of Short-term and Long-term Results after Coronary Bypass Surgery for Ischemic Heart Disease
in Diabetics and Nondiabetics
Charvát J., Stříteský M., Semrád M., Vaněk I., Kvapil M., Vaněček T.:
Interní klinika 2. lékařské fakulty FN v Motole, Praha, přednosta doc. MUDr. M. Kvapil, CSc. Klinika kardiovaskulární chirurgie 1. lékařské fakulty FVL, Praha, přednosta prof. MUDr. I. Vaněk, DrSc. |
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Summary:
In the presented study we have evaluated short-term and long-term results of the multiple aortocoronary bypass surgery in the patients with ischemic heart disease. We have compared the
incidence of the peroperative and postoperative complications, short-term and long-term mortality in the group of diabetics in comparison to nondiabetics as well as the entry characteristics of
both groups. Among 2518 patients who were treated with aortocoronary bypass surgery there
were 773 (30.6 %) diabetics. The diabetic patients were significantly elder, we have found more
women among them, more frequent presence of hypertension, chronic heart failure and peripheral vascular disease. Contrary in the incidence of the previous myocardial infarction we have not
found any significant difference between both groups. The patients with diabetes mellitus had
lower ejection fraction of the left ventricle and significantly more extensive coronary artery
disease which explains that in this group of patients the number of coronary bypasses was
significantly higher. Comparing the incidence of peroperative complications we have not seen
any significant difference between the patients with and without diabetes mellitus. Out of the
postoperative complications we have noticed significantly more renal failure, infectious complications, low cardiac output syndrom and bleeding disorders in the diabetic patients. The duration
of hospitalisation in the intensive care unit was significantly longer in diabetics (55.11 ± 89.09
hours to 47.84 ± 65.18 hours in nondiabetics, p < 0.05). 30 days mortality in diabetics was 3.75 %
and 2.4 % in nondiabetics (p < 0.05). This difference was mainly due to the significantly higher
incidence of multiorgans failure as a cause of death among diabetics (1.3 % in diabetics, 0.5 % in
nondiabetics, p < 0.05). 89.1 % of nondiabetics and 86.9 % of diabetics lived 2 - 6 years after aortocoronary bypass surgery (n.s.). We have found the significantly higher long-term cardiovascular
mortality (2 - 6 years) in diabetics (10,3 %) then in nondiabetics (7.6 %, p < 0.05).
Key words:
Diabetes mellitus - Ischemic heart disease - Aortocoronary bypass - Short-term and
long-term mortality - Postoperative complications
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