Key result
Diabetes mellitus is linked to ~14% lower 16-year relative survival post-CABG versus the background population.
Why the study?
Does metabolic syndrome or diabetes mellitus reduce 16-year survival in patients after CABG?
Cohort (n=910)
Yes
Does metabolic syndrome or diabetes mellitus reduce 16-year survival in patients after CABG?
Effect estimate: Relative survival 0.86 (95% CI 0.82-0.90)
p-value: p=<0.0001
Diabetes mellitus, but not metabolic syndrome alone, is associated with significantly worse 16-year survival after CABG compared to the general population.
DM signals poorer prognosis after CABG unlike isolated MetS; leaves open prospective evaluation of risk modification strategies.
BACKGROUND: The associations of metabolic syndrome (MetS) or diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) have not been extensively evaluated. The aim of the present study was to assess the impact of MetS and DM on the 16-year survival after CABG. METHODS: Diabetic and metabolic status together with relevant cardiovascular data was established in 910 CABG patients operated in 1993-94. They were divided in three groups as follows: neither DM nor MetS (375 patients), MetS alone (279 patients) and DM with or without MetS (256 patients). The 16-year follow-up of patient survival was carried out using national health databases. The relative survival rates were analyzed using the Life Table method comparing the observed survival rates of three patient groups to the rates based on age-, sex- and time-specific life tables for the whole population in Finland. To study the independent significance of MetS and DM for clinical outcome, multivariate analysis was made using an optimizing stepwise procedure based on the Bayesian approach. RESULTS: Bayesian multivariate analysis revealed together six variables to predict clinical outcome (2 months to 16 years) in relation to the national background population, i.e. age, diabetes, left ventricular ejection fraction, BMI, perfusion time during the CABG and peripheral arterial disease. Our principal finding was that after postoperative period the 16-year prognosis of patients with neither DM nor MetS was better than that of the age-, sex-and time-matched background population (relative survival against background population 1.037, p < 0.0001). The overall survival of MetS patients resembled that of the matched background population (relative survival 0.998, NS). DM was associated with significantly increased mortality (relative survival 0.86, p < 0.0001). Additionally, mortality was even higher in patients receiving insulin treatment than in those without. Excess death rate of DM patients was predominantly caused by cardiovascular causes. CONCLUSION: In this long-term follow-up study patient groups without diabetes had at least equal 16 years' survival after CABG than their matched background populations. Survival of DM patients started to deteriorate already few years after the operation.
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Hällberg et al. (2014) conducted a cohort in Coronary artery disease post-CABG (n=910). Diabetes mellitus and metabolic syndrome vs. Patients without diabetes or metabolic syndrome, and matched background population was evaluated on 16-year relative survival compared to matched background population (Relative survival 0.86, 95% CI 0.82-0.90, p=<0.0001). Diabetes mellitus was associated with significantly increased mortality, demonstrating a 16-year relative survival of 0.86 compared to the matched background population after coronary artery bypass grafting.
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