TY - JOUR
T1 - Long-term clinical and angiographic outcomes in patients with diabetes undergoing coronary artery bypass graft surgery
T2 - Results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV Trial
AU - Koshizaka, Masaya
AU - Lopes, Renato D.
AU - Reyes, Eric M.
AU - Gibson, C. Michael
AU - Schulte, Phillip J.
AU - Hafley, Gail E.
AU - Hernandez, Adrian F.
AU - Green, Jennifer B.
AU - Kouchoukos, Nicholas T.
AU - Califf, Robert M.
AU - Ferguson, T. Bruce
AU - Peterson, Eric D.
AU - Alexander, John H.
N1 - Publisher Copyright:
© 2014 Elsevier Inc. All rights reserved.
PY - 2015/1
Y1 - 2015/1
N2 - Background There is limited information about the association between diabetes, its treatment, and long-term angiographic and clinical outcomes in patients undergoing coronary artery bypass graft surgery (CABG). We evaluated the association of diabetes and its treatment with 1-year angiographic graft failure and 5-year clinical outcomes in patients undergoing CABG. Methods Using data from 3,014 patients in PREVENT IV, we analyzed angiographic and clinical outcomes in patients with and without diabetes and among those who did and did not receive insulin before CABG. Logistic regression and Cox proportional hazards models were used to adjust for differences in baseline variables. Results Overall, 1,139 (37.8%) patients had diabetes. Of these, 305 (26.8%) received insulin. One-year rates of vein graft failure were similar in patients with and without diabetes but, among diabetics, tended to be higher in patients who received insulin compared with those who did not. At 5 years, rates of death, myocardial infarction, or revascularization were higher among patients with compared with those without diabetes (adjusted hazard ratio 1.57; 95% CI 1.26-1.96; P b .001) and, among diabetics, higher among those who received insulin (adjusted hazard ratio 1.15; 95% CI 1.02-1.30; P = .02). Conclusions Patients with diabetes had similar rates of vein graft failure but worse clinical outcomes than patients without diabetes. Patients who received insulin had significantly worse clinical outcomes than patients who did not receive insulin. Further studies to better understand the mechanism behind these findings and to improve the outcomes of patients with insulin-requiring diabetes undergoing CABG surgery are warranted.
AB - Background There is limited information about the association between diabetes, its treatment, and long-term angiographic and clinical outcomes in patients undergoing coronary artery bypass graft surgery (CABG). We evaluated the association of diabetes and its treatment with 1-year angiographic graft failure and 5-year clinical outcomes in patients undergoing CABG. Methods Using data from 3,014 patients in PREVENT IV, we analyzed angiographic and clinical outcomes in patients with and without diabetes and among those who did and did not receive insulin before CABG. Logistic regression and Cox proportional hazards models were used to adjust for differences in baseline variables. Results Overall, 1,139 (37.8%) patients had diabetes. Of these, 305 (26.8%) received insulin. One-year rates of vein graft failure were similar in patients with and without diabetes but, among diabetics, tended to be higher in patients who received insulin compared with those who did not. At 5 years, rates of death, myocardial infarction, or revascularization were higher among patients with compared with those without diabetes (adjusted hazard ratio 1.57; 95% CI 1.26-1.96; P b .001) and, among diabetics, higher among those who received insulin (adjusted hazard ratio 1.15; 95% CI 1.02-1.30; P = .02). Conclusions Patients with diabetes had similar rates of vein graft failure but worse clinical outcomes than patients without diabetes. Patients who received insulin had significantly worse clinical outcomes than patients who did not receive insulin. Further studies to better understand the mechanism behind these findings and to improve the outcomes of patients with insulin-requiring diabetes undergoing CABG surgery are warranted.
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U2 - 10.1016/j.ahj.2014.10.013
DO - 10.1016/j.ahj.2014.10.013
M3 - Article
C2 - 25497264
AN - SCOPUS:84925884723
SN - 0002-8703
VL - 169
SP - 175
EP - 184
JO - American heart journal
JF - American heart journal
IS - 1
ER -