Skip to main content
SpringerLink
Log in
Book cover

Coronary Graft Failure pp 145–153Cite as

Coronary Artery Bypass Grafting in Diabetic Patients

  • Chapter
  • First Online:

  • 1017 Accesses

Abstract

The World Health Organization (WHO) has estimated that the global burden of diabetes mellitus (DM) would increase from 135 million in 1995 to 299 million patients by the year 2025. DM is a major risk factor for cardiovascular disease, and arteriosclerosis is responsible for 80 % of short-term deaths in the patients with DM. Coronary artery disease (CAD) is a leading cause of mortality and morbidity in diabetics, accounting for 70–80 % of deaths. DM makes up to 20–35 % of all patients undergoing coronary revascularization. In diabetics, CAD tends to be diffuse, having more complex lesions involving multiple vessels. This makes effective revascularization difficult. Patients with diabetes represent a particularly difficult subset for revascularization due to increased short- and long-term mortality as well as a higher risk of repeat revascularization procedures. Potential factors contributing to the increased risk include co-morbid illnesses; small, diffusely diseased target vessels; progression of native CAD; hyperglycemic endothelial dysfunction; and systemic inflammation. For diabetic patients with multi-vessel disease, revascularization by coronary artery bypass grafting (CABG) is regarded as the preferred option. This chapter presents an overview of CABG in diabetic patients focusing on the evidence for superiority of CABG, technical aspects, and outcomes.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Koochemeshki V, Salmanzadeh HR, Sayyadi H, Amestejani M, Salehi Ardabili S. The effect of diabetes mellitus on short term mortality and morbidity after isolated coronary artery bypass grafting surgery. Int Cardiovasc Res J. 2013;7:41–5.

    PubMed  PubMed Central  Google Scholar 

  2. Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation. 1979;59:8–13.

    Article  CAS  PubMed  Google Scholar 

  3. Robertson WB, Strong JP. Atherosclerosis in persons with hypertension and diabetes mellitus. Lab Invest. 1968;18:538–51.

    CAS  PubMed  Google Scholar 

  4. Waller BF, Palumbo PJ, Lie JT, Roberts WC. Status of the coronary arteries at necropsy in diabetes mellitus with onset after age 30 years. Analysis of 229 diabetic patients with and without clinical evidence of coronary heart disease and comparison to 183 control subjects. Am J Med. 1980;69:498–506.

    Article  CAS  PubMed  Google Scholar 

  5. Thourani VH, Weintraub WS, Stein B, Gebhart SS, Craver JM, Jones EL, Guyton RA. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg. 1999;67:1045–52.

    Article  CAS  PubMed  Google Scholar 

  6. Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA. 2005;293:1501–8.

    Article  CAS  PubMed  Google Scholar 

  7. Bonow RO, Gheorghiade M. The diabetes epidemic: a national and global crisis. Am J Med. 2004;116(Suppl 5A):2S–10.

    Article  PubMed  Google Scholar 

  8. Creager MA, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease pathophysiology, clinical consequences, and medical therapy: part I. Circulation. 2003;108:1527–32.

    Article  PubMed  Google Scholar 

  9. Lee CD, Folsom AR, Pankow JS, Brancati FL. Atherosclersosis Risk in Communities (ARIC) Study Investigators. Cardiovascular events in diabetic and nondiabetic adults with or without history of myocardial infarction. Circulation. 2004;109:855–60.

    Article  PubMed  Google Scholar 

  10. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–34.

    Article  CAS  PubMed  Google Scholar 

  11. Sprafka JM, Burke GL, Folsom AR, McGovern PG, Hahn LP. Trends in prevalence of diabetes mellitus with myocardial infarction and effect of diabetes on survival: the Minnesota heart survey. Diabetes Care. 1991;14:537–43.

    Article  CAS  PubMed  Google Scholar 

  12. Woodfield SL, Lundergan CF, Reiner JS, Greenhouse SW, Thompson MA, Rohrbeck SC, Deychak Y, Simoons ML, Califf RM, Topol EJ, Ross AM. GUSTO-I Angiographic Investigators. Angiographic findings and outcome in diabetic patients treated with thrombolytic therapy for acute myocardial infarction: the GUSTO-1 experience. J Am Coll Cardiol. 1996;28:1661–9.

    Article  CAS  PubMed  Google Scholar 

  13. Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002;40:418–23.

    Article  PubMed  Google Scholar 

  14. Barsness GW, Peterson ED, Ohman EM, Nelson CL, DeLong ER, Reves JG, Smith PK, Anderson RD, Jones RH, Mark DB, Califf RM. Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation. 1997;96:2551–6.

    Article  CAS  PubMed  Google Scholar 

  15. Hammound T, Tanguay JF, Bourassa MG. Management of coronary artery disease: therapeutic options in patients with diabetes. J Am Coll Cardiol. 2000;36:355–65.

    Article  Google Scholar 

  16. Nesto RW. Correlation between cardiovascular disease and diabetes mellitus: current concepts. Am J Med. 2004;116(Suppl 5A):11S–22.

    Article  PubMed  Google Scholar 

  17. Reeder GS, Holmes DR, Lennon RJ, Larson TS, Frye RL. Proteinuria, serum creatinine, and outcome of percutaneous coronary intervention in patients with diabetes mellitus. Am J Cardiol. 2002;89:760–4.

    Article  CAS  PubMed  Google Scholar 

  18. Lemp GF, Vander Zwaag R, Hughes JP, et al. Association between the severity of diabetes mellitus and coronary arterial atherosclerosis. Am J Cardiol. 1987;60:1015–9.

    Article  CAS  PubMed  Google Scholar 

  19. Ledru F, Ducimetiere P, Battaglia S, Courbon D, Beverelli F, Guize L, Guermonprez JL, Diébold B. New diagnostic criteria for diabetes and coronary artery disease: insights from an angiographic study. J Am Coll Cardiol. 2001;37:1543–50.

    Article  CAS  PubMed  Google Scholar 

  20. Goraya TY, Leibson CL, Palumbo PJ, Weston SA, Killian JM, Pfeifer EA, Jacobsen SJ, Frye RL, Roger VL. Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study. J Am Coll Cardiol. 2002;40:946–53.

    Article  PubMed  Google Scholar 

  21. Moreno PR, Murcia AM, Palacios IF, Leon MN, Bernardi VH, Fuster V, Fallon JT. Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation. 2000;102:2180–4.

    Article  CAS  PubMed  Google Scholar 

  22. Silva JA, Escobar A, Collins TJ, Ramee SR, White CJ. Unstable angina: a comparison of angioscopic findings between diabetic and nondiabetic patients. Circulation. 1995;92:1731–6.

    Article  CAS  PubMed  Google Scholar 

  23. Abaci A, Oguzhan A, Kahraman S, Eryol NK, Unal S, Arinç H, Ergin A. Effect of diabetes mellitus on formation of coronary collateral vessels. Circulation. 1999;99:2239–42.

    Article  CAS  PubMed  Google Scholar 

  24. Hermiller JB, Tenaglia AN, Kisslo KB, Phillips HR, Bashore TM, Stack RS, Davidson CJ. In vivo validation of compensatory enlargement of atherosclerotic coronary arteries. Am J Cardiol. 1993;71:665–8.

    Article  CAS  PubMed  Google Scholar 

  25. Vavuranakis M, Stefanadis C, Toutouzas K, Pitsavos C, Spanos V, Toutouzas P. Impaired compensatory coronary artery enlargement in atherosclerosis contributes to the development of coronary artery stenosis in diabetic patients: an in vivo intravascular ultrasound study. Eur Heart J. 1997;18:1090–4.

    Article  CAS  PubMed  Google Scholar 

  26. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, Yang M, Cohen DJ, Rosenberg Y, Solomon SD, Desai AS, Gersh BJ, Magnuson EA, Lansky A, Boineau R, Weinberger J, Ramanathan K, Sousa JE, Rankin J, Bhargava B, Buse J, Hueb W, Smith CR, Muratov V, Bansilal S, King 3rd S, Bertrand M, Fuster V, FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375–84.

    Article  CAS  PubMed  Google Scholar 

  27. BARI 2D Study Group, Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, Orchard TJ, Chaitman BR, Genuth SM, Goldberg SH, Hlatky MA, Jones TL, Molitch ME, Nesto RW, Sako EY, Sobel BE. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15.

    Article  Google Scholar 

  28. Kappetein AP, Head SJ, Morice MC, Banning AP, Serruys PW, Mohr FW, Dawkins KD, Mack MJ, SYNTAX Investigators. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Eur J Cardiothorac Surg. 2013;43:1006–13.

    Article  PubMed  Google Scholar 

  29. Kapur A, Hall RJ, Malik IS, Qureshi AC, Butts J, de Belder M, Baumbach A, Angelini G, de Belder A, Oldroyd KG, Flather M, Roughton M, Nihoyannopoulos P, Bagger JP, Morgan K, Beatt KJ. Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol. 2010;55:432–40.

    Article  PubMed  Google Scholar 

  30. Detre KM, Guo P, Holubkov R, Califf RM, Sopko G, Bach R, Brooks MM, Bourassa MG, Shemin RJ, Rosen AD, Krone RJ, Frye RL, Feit F. Coronary revascularization in diabetic patients: a comparison of the randomized and observational components of the Aypass Angioplasty Revascularization Investigation (BARI). Circulation. 1999;99:633–40.

    Article  CAS  PubMed  Google Scholar 

  31. Detre KM, Lombardero MS, Brooks MM, Hardison RM, Holubkov R, Sopko G, Frye RL, Chaitman BR. The effect of previous coronary-artery bypass surgery on the prognosis of patients with diabetes who have acute myocardial infarction. Bypass Angioplasty Revascularization Investigation Investigators. N Engl J Med. 2000;342:989–97.

    Article  CAS  PubMed  Google Scholar 

  32. Taggart DP. The FREEDOM trial: a definitive answer to coronary artery bypass grafting or stents in patients with diabetes and multivessel coronary artery disease. Eur J Cardiothorac Surg. 2013;44:978–9.

    Article  PubMed  Google Scholar 

  33. Szabó Z, Håkanson E, Svedjeholm R. Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2002;74:712–9.

    Article  PubMed  Google Scholar 

  34. Rajakaruna C, Rogers CA, Suranimala C, Angelini GD, Ascione R. The effect of diabetes mellitus on patients undergoing coronary surgery: a risk-adjusted analysis. J Thorac Cardiovasc Surg. 2006;132:802–10.

    Article  PubMed  Google Scholar 

  35. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007–21.

    Article  CAS  PubMed  Google Scholar 

  36. D’Alessandro C, Leprince P, Golmard JL, Ouattara A, Aubert S, Pavie A, Gandjbakhch I, Bonnet N. Strict glycemic control reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial revascularization. J Thorac Cardiovasc Surg. 2007;134:29–37.

    Article  PubMed  Google Scholar 

  37. Filsoufi F, Rahmanian PB, Castillo JG, Mechanick JI, Sharma SK, Adams DH. Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2007;6:753–8.

    Article  PubMed  Google Scholar 

  38. Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, Guyton RA, Thourani VH. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008;136:631–40.

    Article  PubMed  Google Scholar 

  39. Hudson CC, Welsby IJ, Phillips-Bute B, Mathew JP, Lutz A, Chad Hughes G, Stafford-Smith M, Cardiothoracic Anesthesiology Research Endeavors (C.A.R.E.) Group. Glycosylated hemoglobin levels and outcome in non-diabetic cardiac surgery patients. Can J Anaesth. 2010;57:565–72.

    Article  PubMed  Google Scholar 

  40. Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab. 2010;95:4338–44.

    Article  CAS  PubMed  Google Scholar 

  41. Alserius T, Anderson RE, Hammar N, Nordqvist T, Ivert T. Elevated glycosylated haemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery. Scand Cardiovasc J. 2008;42:392–8.

    Article  CAS  PubMed  Google Scholar 

  42. Halkos ME, Lattouf OM, Puskas JD, Kilgo P, Cooper WA, Morris CD, Guyton RA, Thourani VH. Elevated preoperative hemoglobin A1c level is associated with reduced long-term survival after coronary artery bypass surgery. Ann Thorac Surg. 2008;86:1431–7.

    Article  PubMed  Google Scholar 

  43. Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, McCarthy PM, Cosgrove DM. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999;117:855–72.

    Article  CAS  PubMed  Google Scholar 

  44. Cosgrove DM, Lytle BW, Loop FD, Taylor PC, Stewart RW, Gill CC, Golding LA, Goormastic M. Does bilateral internal mammary artery grafting increase surgical risk? J Thorac Cardiovasc Surg. 1988;95:850–6.

    CAS  PubMed  Google Scholar 

  45. Kurlansky PA, Traad EA, Dorman MJ, Galbut DL, Zucker M, Ebra G. Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. Ann Thorac Surg. 2010;90:101–8.

    Article  PubMed  Google Scholar 

  46. Iribarren C, Go AS, Husson G, Sidney S, Fair JM, Quertermous T, Hlatky MA, Fortmann SP. Metabolic syndrome and early-onset coronary artery disease: is the whole greater than its parts? J Am Coll Cardiol. 2006;48:1800–7.

    Article  CAS  PubMed  Google Scholar 

  47. Yilmaz MB, Guray U, Guray Y, Biyikoglu SF, Tandogan I, Sasmaz H, Korkmaz S. Metabolic syndrome negatively impacts early patency of saphenous vein grafts. Coron Artery Dis. 2006;17:41–4.

    Article  PubMed  Google Scholar 

  48. Dorman MJ, Kurlansky PA, Traad EA, Galbut DL, Zucker M, Ebra G. Bilateral internal mammary artery grafting enhances survival in diabetic patients: a 30-year follow-up of propensity score-matched cohorts. Circulation. 2012;126:2935–42.

    Article  PubMed  Google Scholar 

  49. Endo M, Tomizawa Y, Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes. Circulation. 2003;108:1343–9.

    Article  PubMed  Google Scholar 

  50. Kappetein AP. Bilateral mammary artery vs. single mammary artery grafting: promising early results: but will the match finish with enough players? Eur Heart J. 2010;31:2444–6.

    Article  PubMed  Google Scholar 

  51. Savage EB, Grab JD, O’Brien SM, Ali A, Okum EJ, Perez-Tamayo RA, Eiferman DS, Peterson ED, Edwards FH, Higgins RS. Use of both internal thoracic arteries in diabetic patients increases deep sternal wound infection. Ann Thorac Surg. 2007;83:1002–6.

    Article  PubMed  Google Scholar 

  52. De Paulis R, de Notaris S, Scaffa R, Nardella S, Zeitani J, Del Giudice C, De Peppo AP, Tomai F, Chiariello L. The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: the role of skeletonization. J Thorac Cardiovasc Surg. 2005;129:536–43.

    Article  PubMed  Google Scholar 

  53. Dai C, Lu Z, Zhu H, Xue S, Lian F. Bilateral internal mammary artery grafting and risk of sternal wound infection: evidence from observational studies. Ann Thorac Surg. 2013;95:1938–45.

    Article  PubMed  Google Scholar 

  54. Raja SG. Skeletonized bilateral internal thoracic arteries in patients with diabetes: additional advantages and concerns. J Thorac Cardiovasc Surg. 2004;127:1856–7.

    Article  PubMed  Google Scholar 

  55. Raja SG, Berg GA. Impact of off-pump coronary artery bypass surgery on systemic inflammation: current best available evidence. J Card Surg. 2007;22:445–55.

    Article  PubMed  Google Scholar 

  56. Raja SG. Pump or no pump for coronary artery bypass: current best available evidence. Tex Heart Inst J. 2005;32:489–501.

    PubMed  PubMed Central  Google Scholar 

  57. Raja SG, Dreyfus GD. Current status of off-pump coronary artery bypass surgery. Asian Cardiovasc Thorac Ann. 2008;16:164–78.

    Article  PubMed  Google Scholar 

  58. Magee MJ, Dewey TM, Acuff T, Edgerton JR, Hebeler JF, Prince SL, Mack MJ. Influence of diabetes on mortality and morbidity: off-pump coronary artery bypass grafting versus coronary artery bypass grafting with cardiopulmonary bypass. Ann Thorac Surg. 2001;72:776–80.

    Article  CAS  PubMed  Google Scholar 

  59. Srinivasan AK, Grayson AD, Fabri BM. On-pump versus off-pump coronary artery bypass grafting in diabetic patients: a propensity score analysis. Ann Thorac Surg. 2004;78:1604–9.

    Article  PubMed  Google Scholar 

  60. Emmert MY, Salzberg SP, Seifert B, Rodriguez H, Plass A, Hoerstrup SP, Grünenfelder J, Falk V. Is off-pump superior to conventional coronary artery bypass grafting in diabetic patients with multivessel disease? Eur J Cardiothorac Surg. 2011;40:233–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Harefield Hospital, Harefield, London, UK

    Shahzad G. Raja BSc, MBBS, MRCS, FRCS(C-Th)

Authors
  1. Shahzad G. Raja BSc, MBBS, MRCS, FRCS(C-Th)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shahzad G. Raja BSc, MBBS, MRCS, FRCS(C-Th) .

Editor information

Editors and Affiliations

  1. Cardiology, Army's Center for Cardiovascular Di, Bucharest, Romania

    Ion C. Ţintoiu

  2. Department of Surgery, Chinese University of Hong Kong, Sha Tin, Hong Kong

    Malcolm John Underwood

  3. University Fribourg, Hospital HFR Fribourg, Fribourg, Fribourg, Switzerland

    Stephane Pierre Cook

  4. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan

    Hironori Kitabata

  5. University Medical Center, Texas Tech Univ. Health Science Center, EL PASO, Texas, USA

    Aamer Abbas

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Raja, S.G. (2016). Coronary Artery Bypass Grafting in Diabetic Patients. In: Ţintoiu, I., Underwood, M., Cook, S., Kitabata, H., Abbas, A. (eds) Coronary Graft Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-26515-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26515-5_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26513-1

  • Online ISBN: 978-3-319-26515-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation