The beneficial effect of coronary-artery-bypass surgery on survival in patients with diabetic retinopathy.
OBJECTIVE
The presence of retinopathy is a predictor of mortality following coronary revascularization in diabetics. We studied whether revascularization by coronary-artery-bypass surgery (CABG), as compared with percutaneous coronary intervention (PCI), influences the prognosis in diabetics with retinopathy.


METHODS
Between April 1996 and March 2004, 1489 patients underwent revascularization as an initial procedure. Among these a total of 319 diabetics underwent retinal examination prior to the initial revascularization. These patients were classified according to whether they had retinopathy and whether they had undergone CABG, either initially or after PCI. Mortality rates were estimated from the time of initial revascularization procedure.


RESULTS
The average follow-up from the time of initial revascularization was 48.2+/-28.6 months. In 153 diabetics with retinopathy, 59 eventually underwent CABG. During the entire follow-up period, there were 2 (3.4%) deaths in diabetics with retinopathy who underwent CABG and 14 (14.9%) deaths in those who did not have CABG. Mortality curves differed significantly between the two groups (P = 0.007). After adjustment for risk factors, the relative risk of death was 0.13 afforded by CABG (95% CI, 0.03-0.62; P = 0.011). In 166 diabetics without retinopathy, mortality curves were similar between the patients who underwent CABG and those who did not have CABG (P = 0.94).


CONCLUSIONS
CABG conferred a survival advantage in diabetics with retinopathy. In contrast, no survival advantage was evident in diabetics without retinopathy undergoing CABG. Retinal status should be taken into consideration when considering revascularization strategy for diabetics who have coronary artery disease.
Ohno
Takayuki
T
Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan. takohno-tky@umin.net
Ando
Jiro
J
Ono
Minoru
M
Morita
Toshihiro
T
Motomura
Noboru
N
Hirata
Yasunobu
Y
Takamoto
Shinichi
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003920:Diabetes Mellitus / Q000401:mortality; D003930:Diabetic Retinopathy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015607:Stents; D016019:Survival Analysis