Coronary angiography and aorto-coronary bypass surgery in type 2 diabetic patients.
Diabetic and non-diabetic subjects with angina who underwent angiography and were subsequently treated surgically or medically and followed up for 5 years were analysed in order to assess coronary angiographic findings, efficacy of coronary artery bypass grafting and prognostic criteria in Type 2 diabetic patients with angina as compared to non-diabetic subjects. A total of 1853 of non-diabetic and 145 diabetic subjects underwent angiography, including respectively 857 and 68 who had surgery. Perioperative mortality, survival, reinfarction and asymptomaticity rates were measured. Multivariate analysis of risk factors and clinical features was performed. Diabetic patients had a higher frequency of multi-vessel stenoses (p < 0.001), a greater diffusion of stenoses (p < 0.005) and worse left ventricular motion (p < 0.005). No differences were found in perioperative infarction and mortality. Operated diabetic patients had a higher survival rate (p < 0.001) and a longer symptom-free period (p < 0.05) than unoperated diabetic patients. Operated diabetic patients had similar survival and more frequent recurrence of angina (p < 0.05) than operated non-diabetic patients. Survival rate was lower for unoperated diabetic patients than unoperated non-diabetic patients (p < 0.05). Recurrence of angina was similar. Multivariate analysis did not indicate diabetes as a factor affecting survival. It is concluded that surgery for Type 2 diabetic patients with coronary artery disease is a suitable therapeutic option conferring a reduction in mortality regardless of the presence of diabetes.
Faglia
E
E
Centro di Diabetologia e Malattie Metaboliche, Ospedale Niguarda Cã Granda, Milan, Italy.
Favales
F
F
Brivio
M
M
Pizzi
G L
GL
Campolo
L
L
Cataldo
G
G
Pirelli
S
S
Pellegrini
A
A
Taglieri
C
C
Caroli
A
A
D000328:Adult; D016022:Case-Control Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D015996:Survival Rate