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Snemmkominn árangur kransæðahjáveituaðgerða hjá sjúk­lingum með sykursýki

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Authors
Jónas A. Aðalsteinsson
Tómas A. Axelsson
Daði Helgason
Linda Ó. Árnadóttir
Hera Jóhannesdóttir
Arnar Geirsson
Karl Andersen
Tómas Guðbjartsson
Issue Date
2014-10

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Other Titles
Early outcome in diabetic patients following coronary artery bypass grafting
Citation
Læknablaðið 2014, 100 (10):507-512
Abstract
Inngangur: Sykursýki er einn af helstu áhættuþáttum kransæðasjúkdóms. Sykursjúkir einstaklingar þróa gjarnan þriggja æða kransæðasjúkdóm sem er í flestum tilvikum meðhöndlaður með kransæðahjáveituaðgerð. Í þessari rannsókn voru könnuð áhrif sykursýki á snemmkomna fylgikvilla kransæðahjáveituaðgerða. Efniviður og aðferðir: Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Landspítala á árunum 2001-2012. Af 1626 sjúklingum voru 261 greindir með sykursýki (16%) og voru þeir bornir saman við 1365 sjúklinga án sykursýki. Forspárþættir fylgikvilla og dauða innan 30 daga voru metnir með aðhvarfsgreiningu. Niðurstöður: Aldur, kyn, útbreiðsla kransæðasjúkdóms og EuroSCORE voru sambærileg í báðum hópum, einnig hlutfall hjáveituaðgerða á sláandi hjarta (21%). Sjúklingar með sykursýki höfðu hærri líkamsþyngdarstuðul (30 á móti 28 kg/m2, p<0,01) og voru oftar með háþrýsting (82% á móti 60%, p<0,001) og gaukulsíunarhraða undir 60 ml/mín/1,73m2 (22% á móti 15%, p=0,01). Auk þess var aðgerðartími þeirra 16 mín lengri (p<0,001). Tíðni djúpra bringubeinssýkinga, heilaáfalls og hjartadreps var sambærileg í báðum hópum. Bráður nýrnaskaði var metinn samkvæmt RIFLE-skilmerkjum og voru sykursýkissjúklingar oftar í RISK-flokki (14% á móti 9%, p=0,02) og FAILURE-flokki (2% á móti 0,5%, p=0,01). Minniháttar fylgikvillar (gáttatif, lungnabólga, þvagfærasýking og yfirborðssýking í skurðsári) voru hins vegar svipaðir í báðum hópum. Dánartíðni innan 30 daga var marktækt hærri hjá sjúklingum með sykursýki, eða 5% borið saman við 2% í viðmiðunarhópi (p=0,01). Sykursýki reyndist ekki sjálfstæður áhættuþættur fyrir dauða innan 30 daga þegar leiðrétt var fyrir öðrum áhættuþáttum með fjölþáttaaðhvarfsgreiningu (OR=1,98, 95% ÖB: 0,72-4,95). Ályktanir: Sjúklingar með sykursýki eru í aukinni áhættu á að fá bráðan nýrnaskaða eftir kransæðahjáveituaðgerð en sykursýki virðist ekki vera sjálfstæður forspárþáttur 30 daga dánartíðni.
Introduction: Diabetes is one of the most important risk factors for coronary artery disease. Diabetics often have severe three vessel disease and coronary bypass surgery is in most cases the preferred treatment of choice in these patients. We investigated early surgical complications and outcomes in diabetic patients following isolated CABG in Iceland and compared them to those of non-diabetic patients. Materials and methods: A retrospective study of 1626 consecutive CABG patients operated in Iceland 2001-2012. Diabetic patients were 261 (16%) and were compared to 1365 non-diabetics in terms of patient demographics, operative data, and postoperative outcomes. Logistic regression was used to identify risk factors for major complications and 30-day mortality. Results: The groups were similar in terms of age, gender and Euro-SCORE. Diabetic patients had a higher BMI (30 vs. 28 kg/m2, p<0.001), were more likely to have hypertension (82% vs. 60%, p<0.01) and glomerular filtration rate <60 ml/min/1.73m2 (22% vs. 15%, p=0.01). The rate of deep sternal wound infections, stroke and perioperative myo-cardial infarction was similar in both goups. Acute kidney injury, classified according to the RIFLE-criteria, was higher in diabetic patients, both in the RISK (14% vs. 9%, p=0.02) and FAILURE category (2% vs. 0.5%, p=0.01). Minor complications, (atrial fibrillation, pneumonia, urinary tract infections and superficial wound infections) were similar in both groups. 30-day mortality was 5.0% vs. 2% for diabetics and non-diabetics patients, respectively (p=0.01). Diabetes was not a significant risk factor for 30-day mortality when adjusted for other risk factors with logistic regression (OR=1.98, 95% CI 0.72-4.95). Conclusions: Diabetic patients that underwent CABG more often suffered acute renal injury but diabetes was not an independent prognostic factor of operative mortality.
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Icelandic Journal Articles (Peer Reviewed)

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