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Cirugía coronaria sin circulación extracorpórea con puentes arteriales múltiples en diabéticos: resultados tempranos y alejados;
Off-pump Coronary Artery Bypass Surgery with Multiple Arterial Grafts in Diabetic Patients: Short and Long-term Results

Creators:Navia, Daniel; Jefe de Servicio de Cirugía Cardíaca Instituto Cardiovascular de Buenos Aires, Vrancic, Mariano, Piccinini, Fernando, Benzadón, Mariano, Thierer, Jorge, Dorsa, Alberto, Rossi, Adriana
2013-12-11

Colaborador:

  • Instituto cardiovascular de Buenos Aires

Materia:

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Descripción

La DM es considerado un factor de riesgo independiente de mayor riesgo de mortalidad luego de CRM. El objetivo de este estudio es el de comparar los resultados postoperatorios tempranos y alejados de pacientes con y sin DM luego de CRM sin-CEC con puentes arteriales múltiples y además determinar si la hiperglucemia postoperatoria  es un predictor independiente de morbi-mortalidad temprana. Métodos y pacientes: Es un análisis retrospectivo sobre 1002 pacientes operados en forma consecutiva en el Instituto cardiovascular de Buenos Aires (ICBA), entre enero 2004 y diciembre 2008 en quienes se efectuó CRM sin-CEC con puentes arteriales múltiples. Se dividió la población total estudiada en: pacientes DM (n:234) y no DM (n:768). Se efectuó un análisis de las complicaciones post operatorias y se identificaron predictores independientes de mortalidad hospitalaria para ambos grupos. El seguimiento promedio fue de 1038 + / - 517 días y fue 95,7% completo. Se analizo la sobrevida alejada y la presencia de eventos combinados (muerte, re internación y re intervención) en el grupo de pacientes con y sin DM. Resultados: No hubo diferencias en la mortalidad hospitalaria entre los dos grupos (p = 0,70). Los pacientes DM presentaron mayor incidencia de bajo gasto cardíaco (p = 0,005), fibrilación auricular (p = 0,005) y la infección profunda herida esternal (p = 0,005). Se identificaron predictores independientes de mortalidad hospitalaria: edad (OR = 1,11), CRM no-electiva (OR = 5,88) y glucemia po &gt; 200 mg / dl (OR = 6,9). Los pacientes DM tuvieron menor sobrevida alejada a 5 años que los pacientes no-DM (p = 0,01). Se identificaron predictores independientes de menor sobrevida alejada: DM (HR = 2,1), edad (HR = 1,06), Fey. del ventrículo izquierdo &lt; 40% (HR = 2,45) y creatinina postoperatoria &gt; 1,6 mg / dl (HR = 2,46). Finalmente la presencia de DM (HR = 1,90) y de creatinina postoperatoria &gt; 1,6 mg / dl (HR 2,13) fueron predictores independientes para la presencia de eventos combinados al seguimiento. Conclusión: La CRM sin-CEC con puentes arteriales múltiples en pacientes DM tuvo la misma mortalidad hospitalaria que el grupo de pacientes no-DM. La presencia de hiperglucemia en el po se acompaño de mayor mortalidad hospitalaria. DM y creatinina &gt; 1.6 mg/dl fueron predictores independientes de menor sobrevida alejada.

IntroductionDiabetes mellitus has been identified as a strong independent predictor of cardiovasculardisease onset and progression and acknowledged as a mortality risk factorafter coronary artery surgery. Off-pump coronary artery bypass grafting has been establishedas an efficient alternative to coronary revascularization, comparable to theconventional technique, with results evidencing a reduction in procedure morbidityand, in high risk patients, lower postoperative mortality.ObjectiveThe aims of this study were to compare short and long-term postoperative results ofoff-pump coronary artery revascularization surgery with multiple arterial grafts inpatients with or without diabetes mellitus and to determine if postoperative hyperglycemiais an independent predictor of early morbidity and mortality.MethodsOff-pump coronary revascularization surgery with multiple arterial grafts was consecutivelyperformed on 1002 patients between January 2004 and December 2008.The population was divided in diabetes mellitus (n: 234) and non-diabetes mellitus(n: 768) patients. Post-operative complications were analyzed and independent predictorsof in-hospital mortality were identified. The average follow-up period of 1038± 517 days was completed by 95.7% of patients.ResultsDiabetes mellitus patients had lower cardiac output (p=0.005), atrial fibrillation(p=0.005) and deep sternal wound infection (p=0.005). Age (OR= 1.11), non-electivesurgery (OR=5.88) and blood glucose level &gt; 200 mg/dL (OR= 6.9) were significantpredictors of in-hospital mortality. Five-year survival was lower in diabetesmellitus patients (p=0.01). Diabetes mellitus (HR = 2.1), age (HR= 1.06), left ventricularejection fraction &lt;40% (HR=2.45) and postoperative creatinine &gt; 1.6 mg/dL(HR=2.46) were significant predictors of decreased long-term survival.ConclusionsDiabetes mellitus and non-diabetes mellitus patients had similar in-hospital mortalityrates. Postoperative hyperglycemia was a predictor of greater in-hospital mortality.Diabetes mellitus and creatinine &gt; 1.6 mg/dL were independent predictors ofdecreased long-term survival.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 81, No 6 (2013); 505-512, Argentine Journal of Cardiology; Vol 81, No 6 (2013); 505-512

Citación

Navia, Daniel; Jefe de Servicio de Cirugía Cardíaca Instituto Cardiovascular de Buenos Aires et al., “Cirugía coronaria sin circulación extracorpórea con puentes arteriales múltiples en diabéticos: resultados tempranos y alejados,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/8184.

Dublin Core

Materia

Autor

Navia, Daniel; Jefe de Servicio de Cirugía Cardíaca Instituto Cardiovascular de Buenos Aires
Vrancic, Mariano
Piccinini, Fernando
Benzadón, Mariano
Thierer, Jorge
Dorsa, Alberto
Rossi, Adriana

Fuente

Revista Argentina de Cardiología; Vol 81, No 6 (2013); 505-512
Argentine Journal of Cardiology; Vol 81, No 6 (2013); 505-512

Editor

Sociedad Argentina de Cardiología

Fecha

2013-12-11

Colaborador

Instituto cardiovascular de Buenos Aires

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

Formato

Idioma

spa
eng

Tipo

info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion