Abstract：
BACKGROUND: Diabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS.
METHODS: A retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (n = 905) and diabetic group (n = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed.
RESULTS: After performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (p = .048) with the use of both internal thoracic arteries (p < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (p = .048) and new onset dialysis (p = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (p = .907) comparable between the two groups.
CONCLUSIONS: DM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.
METHODS: A retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (n = 905) and diabetic group (n = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed.
RESULTS: After performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (p = .048) with the use of both internal thoracic arteries (p < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (p = .048) and new onset dialysis (p = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (p = .907) comparable between the two groups.
CONCLUSIONS: DM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.
摘要：
背景：糖尿病（DM）与伴随的合并症有关，如动脉粥样硬化和心血管疾病。冠状动脉旁路移植术（CABG）是糖尿病患者三支血管疾病的最佳治疗方法。DM也被认为是接受选择性CABG手术的患者发病率和死亡率较高的相关危险因素。关于急性冠状动脉综合征（ACS）的糖尿病患者结局的数据是异质的。本研究旨在探讨DM对ACS患者行CABG手术的短期预后的影响。
方法：对2011年6月至2019年10月期间接受了ACS搭桥手术的1370例患者进行了回顾性倾向评分匹配（PSM）分析。将所有患者分为两组：非糖尿病组（n=905）和糖尿病组（n=465）。住院死亡率是主要结果。次要结果是围手术期心肌梗死，新开始的透析，重新开放出血和重症监护病房（ICU）住院时间。还对胰岛素依赖性和非胰岛素依赖性DM患者进行了亚组分析。
结果：执行PSM分析后，两组的基线特征和术前风险状况具有可比性.在非糖尿病组中，使用两个胸廓内动脉（p<.001）进行全动脉血运重建（p=.048）的患者比例明显更高。糖尿病组的围手术期心肌梗死（p=0.048）和新发透析（p=0.008）的发生率明显较高。两组的住院死亡率具有统计学可比性（p=0.907）。
结论：DM与较高的不良结局发生率相关，然而，在接受CABG手术的ACS患者中，院内死亡率相当。
方法：对2011年6月至2019年10月期间接受了ACS搭桥手术的1370例患者进行了回顾性倾向评分匹配（PSM）分析。将所有患者分为两组：非糖尿病组（n=905）和糖尿病组（n=465）。住院死亡率是主要结果。次要结果是围手术期心肌梗死，新开始的透析，重新开放出血和重症监护病房（ICU）住院时间。还对胰岛素依赖性和非胰岛素依赖性DM患者进行了亚组分析。
结果：执行PSM分析后，两组的基线特征和术前风险状况具有可比性.在非糖尿病组中，使用两个胸廓内动脉（p<.001）进行全动脉血运重建（p=.048）的患者比例明显更高。糖尿病组的围手术期心肌梗死（p=0.048）和新发透析（p=0.008）的发生率明显较高。两组的住院死亡率具有统计学可比性（p=0.907）。
结论：DM与较高的不良结局发生率相关，然而，在接受CABG手术的ACS患者中，院内死亡率相当。
