PRE-SURGERY STATUS AND IN-HOSPITAL COMPLICATIONS OF CORONARY BYPASS GRAFTING IN PREDIABETES AND TYPE 2 DIABETES PATIENTS

Abstract

Aim. Investigation of pre-operational status and the rate of in-hospital complications of coronary bypass surgery in patients with prediabetes comparing to diabetes type 2 (DM2) and normoglycemia.Material and methods. Totally, 708 consecutive patients included, post coronary bypass grafting (CBG) in 2011-2012 in the SRI CICVS. If there was no established DM2 diagnosis, but borderline hyperglycemia had existed, patients underwent oral glucose tolerance test (GTT). Its results were interpreted in accordance with the recommended diagnostic criteria for DM2 and other glycemia disorders.Results. Screening before the CBG made it to additionally reveal DM2 in 8,9% (n=63) of the investigated patients, prediabetes — in 10,4% (n=74). This increased the number of patients with established DM2 from 15,2% (n=108) to 24,1% (n=171), with prediabetes — from 3,0% (n=21) to 13,4% (n=95), overall number of persons with glucose metabolism disorder from 18,2% (n=129) to 37,5% (n=266). All participants were then selected to 3 groups by glycemia status: group 1 — no disorders (n=442), group 2 — prediabetes patients (n=95), group 3 — diabetes type 2 (n=171). In analysis of in-hospital complications, the following attracts an attention: in the prediabetes group, specifically, an urgent operation on lower limbs arteries was done more frequently comparing to two other groups (р12=0,002 and р13=0,023). Also, the highest rate of wound complications was in the prediabetes group (р1 =0,012). There was clear trend of comparability of prediabetes and DM2 by the rate of in-hospital complications (odds ratio PR) 1,731, 95% confidence interval (CI) 1,131-2,626, р=0,012), longer hospitalization ^R 2,229, 95% CI 1,4123,519, р<0,001), risk of urgent operation on the lower extremities arteries (OR 1,638, 95% CI 1,009-15,213, р=0,020), multiorgan failure PR 2,911, 95% CI 1,072-7,901, р=0,039), and the need for extra-corporal hemostasis correction ^R 3,472, 95% CI 1,042-11,556, р=0,044). With addition of prediabetes to the regression model and regard of any glucose tolerance disorder as possible predictor of in-hospital complications, all the listed above remained significant, and there was additional relation of prediabetes and diabetes with the risk of acute kidney injury ^R 1,700, 95% CI 1,067-2,612, р=0,024) and wound complications PR 1,547 95% CI 1,0732,231, р=0,019).Conclusion. Prediabetes is the same adverse as diabetes in its influence on inhospital prognosis of CBG, that underscores the importance of active preoperational screening of glucose intolerance.

Keywords

• myocardial revascularization
• coronary bypass
• pre-diabetes
• diabetes mellitus
• pre-surgery status
• screening for glucose intolerance
• in-hospital adverse outcomes