Serum Low-Density Lipoprotein Levels Predict Mid-Term Outcomes of Diabetic Patients After Off-Pump Coronary Artery Bypass Surgery

Objective: Metabolic disorders, such as higher low-density lipoprotein cholesterol (LDL-C) levels and diabetes mellitus are associated with an increased risk of adverse events in the secondary prevention of coronary artery disease. These metabolic disorders are also associated with adverse events after coronary artery bypass surgery. However, few reports describe the relationship between postoperative outcomes and preoperative serum levels of mediators including levels of fasting blood sugar (FBS), hemoglobin A1c (HbA1c) and LDL-C. This study assesses the impact of metabolic makers, including LDL-C, on midterm outcomes of patients with diabetes after off-pump coronary artery bypass surgery. Patients: We enrolled 350 diabetic patients who underwent isolated off-pump coronary artery bypass surgery at our institution between 2003 and 2007. Methods: Predictors of all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE) were identified using the Cox proportional-hazards model adjusted for LDL-C, HbA1c, FBS and other risk factors at baseline. Results: During 2. 7 ± 1. 6 years of follow-up, 27 patients died (including six cardiac deaths) and 25 developed major adverse cardiac and cerebrovascular event. Multivariate analysis revealed associations between increased LDL-C and all-cause death (hazards ratio [HR], 1. 01;95% confidence interva [l CI], 1.00-1. 03;p=0. 0333), cardiac death (HR, 1. 05;95% CI, 1. 02-1.09; p = 0. 0001) and MACCE (HR, 1. 02;95% CI, 1. 01-1. 03;p = 0. 0054). However, increased FBS and HbA1c were not associated with survival and MACCE. Conclusions: Higher LDL-C level, but not FBS or HbA1c, was an independent predictor of all-cause death, cardiac death and MACCE in diabetic patients after off-pump CABG.