Key result
Failure to achieve goal systolic blood pressure was associated with increased 5-year all-cause mortality (HR 1.573; 95% CI 1.048-2.362; P=0.029) in patients with diabetes post-CABG.
Why the study?
CABG is the preferred revascularization strategy for most patients with diabetes and multivessel disease, but the role of optimized perioperative cardiometabolic targets on long-term survival required evaluation.
Does achievement of optimized perioperative cardiometabolic targets improve long-term survival in patients with diabetes undergoing CABG?
Cohort (n=1,273)
No
Does achievement of optimized perioperative cardiometabolic targets improve long-term survival in patients with diabetes undergoing CABG?
Hazard Ratio: 1.573 (95% CI 1.048–2.362)
p-value: p=0.029
Perioperative blood pressure control and statin therapy are critical determinants of 5-year survival in patients with diabetes undergoing CABG.
Supports perioperative SBP control in diabetic CABG patients; leaves open whether optimization improves survival in randomized trials.
Background Coronary artery bypass graft (CABG) surgery represents the preferred revascularization strategy for most patients with diabetes and multivessel disease. We aimed to evaluate the role of optimized, perioperative cardiometabolic targets on long‐term survival in patients who underwent CABG. Methods and Results Single‐institution retrospective study was conducted in patients with diabetes who underwent CABG between January 2010 and June 2018. Demographic, surgical, and cardiometabolic determinants were identified during the perioperative period. Clinical characteristics and longitudinal survival outcomes data were obtained. A total of 1534 patients with CABG were considered for analysis and 1273 met inclusion criteria. The mean age of patients was 63.3 years (95% CI, 62.7–63.8 years), and most were men (65%) and Hispanic or Latino (47%). Comorbidities included hypertension (95%) and dyslipidemia (88%). In total, 490 patients (52%) had a low‐density lipoprotein cholesterol level >70 mg/dL. Furthermore, 390 patients (31%) had uncontrolled systolic blood pressure >130 mm Hg. Last, only 386 patients (29%) had a hemoglobin A 1c level between 6% and 7%. At 5 years, 121 patients (10%) died. Failure to achieve goal systolic blood pressure was associated with all‐cause (hazard ratio [HR], 1.573; 95% CI, 1.048–2.362 [ P =0.029]) and cardiovascular (HR, 2.023; 95% CI, 1.196–3.422 [ P =0.009]) mortality at 5 years post‐CABG. In contrast, prescription of a statin during the perioperative interval demonstrated a protective effect for all‐cause (HR, 0.484; 95% CI, 0.286–0.819 [ P =0.007]) and cardiovascular (HR, 0.459; 95% CI, 0.229–0.920 [ P =0.028]) mortality. There was no association between achievement of low‐density lipoprotein cholesterol, triglycerides, non–high‐density lipoprotein cholesterol, or hemoglobin A 1c level goals and mortality risk at 5 years. Conclusions Among patients with diabetes, blood pressure control and statin therapy were the most important perioperative cardiometabolic survival determinants 5 years after CABG.
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Skendelas et al. (2022) conducted a cohort in Diabetes and multivessel disease undergoing CABG (n=1,273). Failure to achieve goal systolic blood pressure (>130 mm Hg) vs. Achieved goal systolic blood pressure was evaluated on All-cause mortality at 5 years (HR 1.573, 95% CI 1.048-2.362, p=0.029). Failure to achieve goal systolic blood pressure was associated with increased 5-year all-cause mortality (HR 1.573; 95% CI 1.048-2.362; P=0.029) in patients with diabetes post-CABG.
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