Long-Term Survival after CABG in Diabetics with Aggressive Risk Factor Management


Objectives: Diabetes is a well-established risk factor for cardiovascular disease, and diabetics have a threefold increase in risk of death from cardiovascular disease compared to non-diabetics. Following coronary artery bypass grafting, tight glycemic control improves short-term outcomes, however limited data exist for long-term outcomes. Here we examine these outcomes in diabetics using aggressive risk factor management. Methods: A retrospective review of all patients under-going coronary artery bypass between 1991 and 2000 at a single Veterans Affairs Medical Center was undertaken. 973 patients were included, 313 with diabetes and 660 without. Strict glucose control was maintained for all patients. Additional risk factor modification, including anti-platelets medications, statins, and beta blockers were also used. Survival analysis was performed. Results: The diabetic group was at higher risk, with age, BSA, and NYHA class all being greater (p < 0.05). The mean follow-up time was 6.7 ± 3 years. There were 28 deaths/1000 person-years for non-diabetics, and 48 deaths/1000 person-years for diabetics. Survival rates were significantly higher for non-diabetics (72% versus 58% in the diabetic group, p < 0.001). Cox proportional hazard analysis demonstrated mortality risk was 57% higher for diabetic patients (hazard ratio = 1.57; CI: 1.19 - 2.09; p = 0.002). The mortality risk in diabetics with and without prior MI was similar (HR = 0.83; CI: 0.54 - 1.28; p = 0.40). Conclusions: Diabetics undergoing coronary bypass have poorer long-term survival than non-diabetics despite perioperative glycemic control and risk factor modification. The long-term survival decrease in diabetics with history of MI is attenuated with surgical revascularization.

Share and Cite:

Endicott, K. , Hynes, C. , Emerson, D. , Kokkinos, P. , Greenberg, M. and Trachiotis, G. (2014) Long-Term Survival after CABG in Diabetics with Aggressive Risk Factor Management. World Journal of Cardiovascular Surgery, 4, 217-222. doi: 10.4236/wjcs.2014.412031.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Vaccaro, O., Eberly, L.E., et al. (2004) Impact of Diabetes and Previous Myocardial Infarction on Long-Term Survival: 25 Year Mortality Follow-Up of Primary Screenees of the Multiple Risk Factor Intervention Trial. Archives of Internal Medicine, 164, 1438-1443.
[2] Skyler, J.S., Bergenstal, R., et al. (2008) Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the Accord, Advnace, and VA Diabetes Trials. Journal of the American College of Cardiology, 53, 298-304.
[3] Smith Jr., S.C., Greenland, P. and Grundy, S.M. (2000) Prevention Conference V: Beyond Secondary Prevention: Identifying the High-Risk Patient for Primary Prevention: Executive Summary. Circulation, 101, 111-116.
[4] Creager, M.A. and Lüscher, T.F. (2003) Diabetes and Vascular Disease: Pathophysiology, Clinical Consequences, and Medical Therapy: Part I. Circulation, 108, 1527-1532.
[5] Beckman, J.A., Creager, M.A. and Libby, P. (2002) Diabetes and Atherosclerosis. JAMA, 287, 2570-2581.
[6] NICE-SUGAR Study Investigators, et al. (2009) Intensive versus Conventional Glucose Control in Critically Ill Patients. The New England Journal of Medicine, 360, 1283-97.
[7] Juvenile Diabetes Research Foundation Continuous Clucose Monitoring Study Group, et al. (2008) Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes. The New England Journal of Medicine, 359, 1464-1476.
[8] Holman, R.R., Paul, S.K., et al. (2008) Long-Term Follow-Up after Tight Control of Blood Pressure in Type 2 Diabetes. The New England Journal of Medicine, 359, 1565-1576.
[9] Holman, R.R., Paul, S.K., et al. (2008) 10-Year Follow-Up of Intensive Glucose Control in Type 2 Diabetics. The New England Journal of Medicine, 359, 1577-1589.
[10] Jacoby, R.M. and Nesto, R.W. (1992) Acute Myocardial Infarction in the Diabetic Patient: Pathophysiology, Clinical Course and Prognosis. Journal of the American College of Cardiology, 20, 736-744.
[11] Cho, E., Rimm, E.B., et al. (2002) The Impact of Diabetes Mellitus and Prior Myocardial Infarction on Mortality from All Causes and from Coronary Heart Disease in Men. Journal of the American College of Cardiology, 40, 954-960.
[12] BARI 2D Study Group, et al. (2009) A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease. The New England Journal of Medicine, 360, 2503-2515.
[13] Chaitman, B.R. and Hardison, R.M. (2009) The Bypass Angioplasty Revascularization Investigation 2 Diabetes Randomized Trial of Different Treatment Strategies in Type 2 Diabetes Mellitus with Stable Ischemic Heart Disease. Circulation, 120, 2529-2540.
[14] Mack, M.J., Banning, A.P., et al. (2011) Bypass versus Drug-Eluting Stents at Three Years in Syntax Patients With Diabetes Mellitus or Metabolic Syndrome. The Annals of Thoracic Surgery, 92, 2140-2146.
[15] BARI Study Group, et al. (1997) Influence of Diabetes on 5-Year Mortality and Morbidity in a Randomized Trial Comparing CABG and PTCA in Patients With Multivessel Disease: The Bypass Angioplasty Revascularization Investigation (BARI). Circulation, 96, 1761-1769.
[16] Lazar, H.L., Chipkin, S.R., et al. (2004) Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events. Circulation, 109, 1497-1502.
[17] Wannamethee, S.G., Shaper, A.G. and Lennon, L. (2004) Cardiovascular Disease Incidence and Mortality in Older Men with Diabetes and in Men with Coronary Heart Disease. Heart, 90, 1398-1403.
[18] Thourani, V.H., Weintraub, W.S., et al. (1999) Influence of Diabetes Mellitus on Early and Late Outcome after Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery, 67, 1045-1052.
[19] Salem, R., Denault, A.Y., Couture, P., et al. (2006) Left Ventricular End-Diastolic Pressure Is a Predictor of Mortality in Cardiac Surgery Independently of Left Ventricular Ejection Fraction. British Journal of Anaesthesia, 97, 292-297.
[20] Nashef, S.A., Roques, F., Sharples, L.D., Nilsson, J., Smith, C., Goldstone, A.R. and Lockowandt, U. (2012) EuroSCORE II. European Journal Cardio-Thoracic Surgery, 41, 734-745.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.