Impact of diabetic retinopathy on cardiac outcome after coronary artery bypass graft surgery: prospective observational study.
BACKGROUND
Diabetic retinopathy is a manifestation of more severe diabetes. We sought to assess the impact of diabetic retinopathy on cardiac outcome of coronary artery bypass graft surgery (CABG).


METHODS
We prospectively assessed the status of the retina of 74 consecutive diabetics who were referred for first-time CABG, and compared cardiac outcome of CABG in diabetics with retinopathy with that in those without retinopathy. Cardiac events included recurrent angina or congestive heart failure that needed admission to hospital, myocardial infarction, repeat revascularization, and cardiac death.


RESULTS
Twenty-six diabetics had retinopathy and 48 diabetics did not have retinopathy. Diabetics with retinopathy were likely to have higher hemoglobin A1c level (p = 0.048), and receive insulin treatment (p = 0.0065). In the 12 months of follow-up, 13 cardiac events occurred in diabetics with retinopathy and 7 in those without retinopathy (p = 0.0021). Among diabetics with retinopathy, heart failure or death due to heart failure accounted for 54% (7 of 13) of these cardiac events. Kaplan-Meier analysis showed significant difference in cardiac event-free survival between the two groups (p < 0.001). After adjustment for differences in patients' characteristics, diabetic retinopathy remained a predictor of cardiac event (adjusted relative risk = 4.2, 95% confidence interval, 1.5% to 11.9%; p = 0.0067).


CONCLUSIONS
After CABG, diabetics with retinopathy have a substantially increased risk of cardiac events, especially of congestive heart failure.
Ono
Takayuki
T
Department of Cardiothoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan. takohno@hotmail.com
Ohashi
Takeki
T
Asakura
Teiji
T
Ono
Nagara
N
Ono
Minoru
M
Motomura
Noboru
N
Takamoto
Shinichi
S
D000787:Angina Pectoris / Q000209:etiology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome