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. 2023 Mar 11;23(1):130.
doi: 10.1186/s12872-023-03163-5.

Type 2 diabetes mellitus and In-hospital Major Adverse Cardiac and Cerebrovascular Events (MACCEs) and postoperative complications among patients undergoing on-pump isolated coronary artery bypass surgery in Northeastern Iran

Mahin Nomali #  1   2 , Aryan Ayati #  3 , Amirhossein Tayebi  4 , Mohammad Eghbal Heidari  5 , Keyvan Moghaddam  6 , Soheil Mosallami  6 , Gholamali Riahinokandeh  7 , Mahdis Nomali  8 , Gholamreza Roshandel  9
Affiliations

Type 2 diabetes mellitus and In-hospital Major Adverse Cardiac and Cerebrovascular Events (MACCEs) and postoperative complications among patients undergoing on-pump isolated coronary artery bypass surgery in Northeastern Iran

Mahin Nomali et al. BMC Cardiovasc Disord. .

Abstract

Background: Diabetes Mellitus (DM) is a rapidly growing disorder worldwide, especially in the Middle East. A higher incidence of coronary artery diseases requiring coronary artery bypass graft (CABG) surgery has been reported in patients with diabetes. We assessed the association between type 2 diabetes mellitus (T2DM) and in-hospital major adverse cardiac and cerebrovascular events (MACCEs) and postoperative complications among patients who underwent on-pump isolated CABG.

Methods: In this retrospective cohort study, we used the data registered for CABG patients from two heart centers in the Golestan province (North of Iran) between 2007 and 2016. The study population included 1956 patients divided into two groups: 1062 non-diabetic patients and 894 patients with diabetes (fasting plasma glucose ≥126 mg/dl or using antidiabetic medications). The study outcome was in-hospital MACCEs, a composite outcome of myocardial infarction (MI), stroke and cardiovascular death, and postoperative complications, including postoperative arrhythmia, acute atrial fibrillation (AF), major bleeding (defined as reoperation due to bleeding), and acute kidney injury (AKI).

Results: During the 10-year study period, 1956 adult patients with a mean (SD) age of 59.0 (9.60) years were included. After adjustment for age, gender, ethnicity, obesity, opium consumption, and smoking, diabetes was a predictor of postoperative arrhythmia (AOR 1.30, 95% CI 1.08-1.57; P = 0.006). While it was not a predictor of in-hospital MACCEs (AOR 1.35, 95% CI 0.86, 2.11; P = 0.188), AF (AOR 0.85, 95% CI 0.60-1.19; P = 0.340), major bleeding (AOR 0.80, 95% CI 0.50, 1.30; P = 0.636) or AKI (AOR 1.29, 95% CI 0.42, 3.96; P 0.656) after CABG surgery.

Conclusion: Findings indicated that diabetes increased the risk of postoperative arrhythmia by 30%. However, we found similar in-hospital MACCEs, acute AF, major bleeding, and AKI following CABG surgery in both diabetic and non-diabetic patients.

Keywords: Complications; Coronary artery bypass; Diabetes Mellitus, Type2; Major adverse cardiovascular events; Retrospective studies.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study population diagram
Fig. 2
Fig. 2
Postoperative complications by diabetes. MACCEs: Major adverse cardiac and cerebrovascular events (i.e., composite of MI, stroke and cardiovascular death). Post-op: Postoperative. AF: Atrial fibrillation. DM: Diabetes. AKI: Acute kidney injury. P: Probability value (i.e. P < 0.05 was considered as statistically significant)
Fig. 3
Fig. 3
Adjusted odds ratios for study outcomes. MACCEs: Major adverse cardiac and cerebrovascular events (i.e., composite of MI, stroke and cardiovascular death). Post-op: Postoperative. AF: Atrial fibrillation
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