TY - JOUR
T1 - Perioperative Cardiometabolic Targets and Coronary Artery Bypass Surgery Mortality in Patients With Diabetes
AU - Skendelas, John P.
AU - Phan, Donna K.
AU - Friedmann, Patricia
AU - Rodriguez, Carlos J.
AU - Stein, Daniel
AU - Arbab-Zadeh, Armin
AU - Forest, Stephen J.
AU - Slipczuk, Leandro
N1 - Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2022/5/3
Y1 - 2022/5/3
N2 - BACKGROUND: Coronary artery bypass graft (CABG) surgery represents the preferred revascularization strategy for most patients with diabetes and multivessel disease. We aimed to evaluate the role of optimized, perioperative cardiometabolic targets on long-term survival in patients who underwent CABG. METHODS AND RESULTS: Single-institution retrospective study was conducted in patients with diabetes who underwent CABG between January 2010 and June 2018. Demographic, surgical, and cardiometabolic determinants were identified during the perioperative period. Clinical characteristics and longitudinal survival outcomes data were obtained. A total of 1534 patients with CABG were considered for analysis and 1273 met inclusion criteria. The mean age of patients was 63.3 years (95% CI, 62.7– 63.8 years), and most were men (65%) and Hispanic or Latino (47%). Comorbidities included hypertension (95%) and dyslipidemia (88%). In total, 490 patients (52%) had a low-density lipoprotein cholesterol level >70 mg/dL. Furthermore, 390 patients (31%) had uncontrolled systolic blood pressure >130 mm Hg. Last, only 386 patients (29%) had a hemoglobin A1c level between 6% and 7%. At 5 years, 121 patients (10%) died. Failure to achieve goal systolic blood pressure was associated with all-cause (hazard ratio [HR], 1.573; 95% CI, 1.048– 2.362 [P=0.029]) and cardiovascular (HR, 2.023; 95% CI, 1.196– 3.422 [P=0.009]) mortality at 5 years post-CABG. In contrast, prescription of a statin during the perioperative interval demonstrated a protective effect for all-cause (HR, 0.484; 95% CI, 0.286– 0.819 [P=0.007]) and cardiovascular (HR, 0.459; 95% CI, 0.229– 0.920 [P=0.028]) mortality. There was no association between achievement of low-density lipoprotein cholesterol, triglycer-ides, non– high-density lipoprotein cholesterol, or hemoglobin A1c level goals and mortality risk at 5 years. CONCLUSIONS: Among patients with diabetes, blood pressure control and statin therapy were the most important perioperative cardiometabolic survival determinants 5 years after CABG.
AB - BACKGROUND: Coronary artery bypass graft (CABG) surgery represents the preferred revascularization strategy for most patients with diabetes and multivessel disease. We aimed to evaluate the role of optimized, perioperative cardiometabolic targets on long-term survival in patients who underwent CABG. METHODS AND RESULTS: Single-institution retrospective study was conducted in patients with diabetes who underwent CABG between January 2010 and June 2018. Demographic, surgical, and cardiometabolic determinants were identified during the perioperative period. Clinical characteristics and longitudinal survival outcomes data were obtained. A total of 1534 patients with CABG were considered for analysis and 1273 met inclusion criteria. The mean age of patients was 63.3 years (95% CI, 62.7– 63.8 years), and most were men (65%) and Hispanic or Latino (47%). Comorbidities included hypertension (95%) and dyslipidemia (88%). In total, 490 patients (52%) had a low-density lipoprotein cholesterol level >70 mg/dL. Furthermore, 390 patients (31%) had uncontrolled systolic blood pressure >130 mm Hg. Last, only 386 patients (29%) had a hemoglobin A1c level between 6% and 7%. At 5 years, 121 patients (10%) died. Failure to achieve goal systolic blood pressure was associated with all-cause (hazard ratio [HR], 1.573; 95% CI, 1.048– 2.362 [P=0.029]) and cardiovascular (HR, 2.023; 95% CI, 1.196– 3.422 [P=0.009]) mortality at 5 years post-CABG. In contrast, prescription of a statin during the perioperative interval demonstrated a protective effect for all-cause (HR, 0.484; 95% CI, 0.286– 0.819 [P=0.007]) and cardiovascular (HR, 0.459; 95% CI, 0.229– 0.920 [P=0.028]) mortality. There was no association between achievement of low-density lipoprotein cholesterol, triglycer-ides, non– high-density lipoprotein cholesterol, or hemoglobin A1c level goals and mortality risk at 5 years. CONCLUSIONS: Among patients with diabetes, blood pressure control and statin therapy were the most important perioperative cardiometabolic survival determinants 5 years after CABG.
KW - CABG
KW - cardiometabolic
KW - coronary artery disease
KW - diabetes
KW - hypertension
KW - lipids
KW - mortality
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U2 - 10.1161/JAHA.121.023558
DO - 10.1161/JAHA.121.023558
M3 - Article
C2 - 35475344
AN - SCOPUS:85129781788
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e023558
ER -
