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Coronary artery disease
Original research
Preoperative disturbances of glucose metabolism and mortality after coronary artery bypass grafting
  1. Catarina Djupsjo1,
  2. Ulrik Sartipy2,
  3. Torbjorn Ivert2,
  4. Stelios Karayiannides3,
  5. Pia Lundman3,
  6. Thomas Nystrom4,
  7. Martin J Holzmann1 and
  8. Jeanette Kuhl1
  1. 1Medicine, Karolinska Institute, Stockholm, Stockholm County, Sweden
  2. 2Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Stockholm County, Sweden
  3. 3Clinical Sciences, Karolinska Institute, Stockholm, Stockholm County, Sweden
  4. 4Clinical Science and Research, Karolinska Institute, Stockholm, Stockholm County, Sweden
  1. Correspondence to Dr Jeanette Kuhl; Jeanette.kuhl{at}ki.se

Abstract

Background Disturbances of glucose metabolism are important risk factors for coronary artery disease and are associated with an increased mortality risk. The aim was to investigate the association between preoperative disturbances of glucose metabolism and long-term all-cause mortality after coronary artery bypass grafting (CABG).

Methods Patients undergoing a first isolated CABG in 2005–2013 were included. All patients without previously known diabetes underwent an oral glucose tolerance test (OGTT) before surgery. They were categorised as having normal glucose tolerance (NGT), pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) or newly discovered diabetes. Data were collected from nationwide healthcare registers. Cox regression was used to calculate adjusted HR with 95% CI for death in patients with pre-diabetes and diabetes, using NGT as reference.

Results In total, 497 patients aged 40–86 years were included. According to OGTT, 170 (34%) patients had NGT, 219 (44%) patients with pre-diabetes and 108 (22%) patients had newly discovered diabetes. Baseline characteristics were similar between the groups except for slightly higher age among patients with newly discovered diabetes. There were 133 (27%) deaths during a mean follow-up time of 10 years. The cumulative 10-year survival was 77% (69%–83%), 83% (77%–87%) and 71% (61%–79%) in patients with NGT, pre-diabetes and newly discovered diabetes, respectively. There was no significant difference in all-cause mortality between the groups after multivariable adjustment.

Conclusion In this study, patients with pre-diabetes or newly discovered diabetes prior to CABG had similar long-term survival compared with patients with NGT.

  • coronary artery disease
  • diabetic heart disease
  • acute coronary syndrome
  • surgery-coronary bypass
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001217

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    Footnotes

    • Presented at This work has been presented as an abstract at the 55th Annual EASD meeting in Barcelona, Spain, 16–20 September 2019.

    • Contributors JK, US, MJH and CD have contributed to the conception and design of the work. JK and CD have written and substantively revised the work and were major contributors to writing the manuscript. US analysed the material, ran the statistics and helped with the interpretation of the data. TI collected the OGTT results in patients with an elective CABG. PL, SK and CD collected the OGTT results in patients treated for ACS by manually reviewing patients' medical records. TN provided valuable information regarding interpretations of the glucose metabolism. All authors have read and approved the final manuscript. JK and CD are responsible for the overall content as guarantors. The final manuscript has been seen and approved by all authors, and all authors have taken due care to ensure the integrity of the work.

    • Funding JK was supported by grants from the Swedish Society of Medicine (SLS-586711) and Signe och Olof Wallenius Stiftelse. US was supported by the Swedish Heart-Lung Foundation (grant numbers 20160522, 20160525 and 20180400), Åke Wiberg Foundation (grant number M18-0016), Karolinska Institutet Foundations and Funds (grant number 2018–01784), and the regional ALF agreement between Stockholm County Council and Karolinska Institutet (grant number 20180114).

    • Competing interests MJH has received consultancy honoraria from Actelion, Idorsia and Pfizer. PL has received consultancy honoraria from Amgen and Sanofi.

    • Patient consent for publication Not required.

    • Ethics approval The study complied with the Declaration of Helsinki and was approved by the regional research ethics committee in Stockholm, Sweden (2014/338-31/2).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Data sharing not applicable due to Swedish law.