Key result
Preoperative iron deficiency linked to ~57% lower odds of significant EF improvement post-CABG in diabetics.
Why the study?
There is limited information regarding the impact of iron deficiency on patients undergoing cardiac surgery, prompting this evaluation of preoperative iron deficiency on outcomes in type 2 diabetes patients undergoing CABG.
Does preoperative iron deficiency impair the significant improvement of follow-up ejection fraction in T2DM patients undergoing CABG?
Cohort (n=302)
No
Does preoperative iron deficiency impair the significant improvement of follow-up ejection fraction in T2DM patients undergoing CABG?
Effect estimate: OR 0.43 (95% CI 0.24-0.98)
Absolute Event Rate: 12.9% vs 25.4%
p-value: p=0.043
Preoperative iron deficiency in T2DM patients undergoing CABG is associated with a significantly lower likelihood of early left ventricular ejection fraction recovery.
Preoperative iron deficiency was associated with reduced post-CABG LVEF recovery in T2DM; leaves open whether repletion improves outcomes.
Background: Iron deficiency (ID) is one of the most common micronutrient deficiencies affecting public health. Studies show that ID affects the prognosis of patients with heart disease, including heart failure, coronary artery disease and myocardial infarction. However, there is limited information regarding the impact of ID on patients undergoing cardiac surgery. This study aimed to evaluate the influence of preoperative ID on the prognosis of type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG). Methods: In the Glycemic control using mobile-based intervention in patients with diabetes undergoing coronary artery bypass to promote self-management (GUIDEME) study, patients with T2DM undergoing CABG were prospectively recruited. In this study, only those patients with preoperative iron metabolism results were enrolled. Patients were grouped based on the presence of preoperative ID. The primary endpoint was defined as the significant improvement of follow-up ejection fraction (EF) compared to postoperative levels (classified according to the 75th percentile of the change, and defined as an improvement of greater than or equal to 5%). Univariable logistic regression was performed to explore the potential confounders, followed by multiple adjustment. Results: A total of 302 patients were enrolled. No deaths were observed during the study period. A higher incidence of the primary endpoint was observed in the ID group (25.4% vs 12.9%, p = 0.015). The postoperative and follow-up EF were similar beween the two groups. In the regression analysis, ID was noticed to be a strong predictor against the significant improvement of EF in both univariable (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.22–0.86, p = 0.017) and multivariable (OR: 0.43, 95% CI: 0.24–0.98, p = 0.043) logistic regression. In the subgroup analysis, ID was a predictor of significant improvement of EF in age ≤60 years, male, EF ≤60%, and on-pump CABG patients. Conclusions: In T2DM patients undergoing CABG, ID might negatively affect the early recovery of left ventricular systolic function in terms of recovery of EF 3–6 months after surgery, especially in patients age ≤60 years, males, EF ≤60% and in those undergoing on-pump CABG.
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Nan et al. (2023) conducted a cohort in Type 2 diabetes mellitus undergoing coronary artery bypass grafting (n=302). Preoperative iron deficiency vs. No iron deficiency was evaluated on Significant improvement of follow-up ejection fraction (≥5% improvement compared to postoperative levels) (OR 0.43, 95% CI 0.24-0.98, p=0.043). Preoperative iron deficiency independently reduced the likelihood of significant ejection fraction improvement (OR 0.43) 3 to 9 months after coronary artery bypass grafting in diabetic patients.
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