Coronary Artery Bypass Grafting in Patients with Diabetes Mellitus: A Cardiologist’s View

The review presents current data on the prevalence of diabetes in the cohort of patients undergoing coronary artery bypass grafting. The relevance of active approach to the identification of diabetes and prediabetes in patients with coronary artery disease (CAD) before coronary revascularization is reviewed. Recent information about the negative impact of diabetes on the prognosis of myocardial revascularization is reported as well as the main mechanisms responsible to the development of adverse outcomes of interventions in these patients. Target perioperative values of glycemia recommended by the leading associations of the study of diabetes have been compared. Beneficial potential of other carbohydrate metabolism markers (glycated hemoglobin, fructosamine, 1,5-anhydroglucitol) in patients with diabetes mellitus (DM) in terms of their impact on cardiovascular prognosis, including coronary intervention. The results of studies comparing different management strategies for these patients are reviewed. The significance of carbohydrate metabolism compensation during myocardial revascularization is reported; thus, a too stringent glycemic control has no benefits neither for percutaneous nor for open coronary intervention. Recent trials suggest the groups of antidiabetic drugs and evidence of their impact on the cardiovascular system. The importance of comprehensive monitoring of major risk factors in diabetic patients with coronary intervention has been proved

Neuropsychological dynamics in patients with type 2 diabetes mellitus undergone coronary artery bypass grafting

AIM: The study was aimed at evaluation of hospital neuropsychological dynamics in ischemic heart disease patients with comorbid type 2 diabetes mellitus (T2DM) undergone on-pump coronary artery bypass grafting. MATERIALS AND METHODS: 14 from a total of 37 examined patients had T2DM. Diabetic patients were found to have lower attention parameters prior to the intervention in comparison to non-diabetic controls. At days 7-10 after the surgery all patients demonstrated deterioration of cognitive functions. RESULTS: We observed deeper deterioration in diabetic patients, regarding attention, memory, sensorimotor speed and quantity of erroneous test responses, as measured against individuals with normal glucose tolerance. CONCLUSIONS: Diabetic patients undergone coronary artery bypass surgery show lower cognitive characteristics when compared to controls without T2DM, suggesting this cohort to be a high-risk group for further cognitive decline

Prognostic significance of proinflammatory factors in patients with progressive angina pectoris and type 2 diabetes mellitus

Aims. Our study was aimed to assess the influence of non-specific inflammation and endothelial dysfunction on developmentof cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and progressive angina pectoris. Materials and methods. 140 patients (63 of them were also diabetic) received follow-up for cardiovascular events during12 months after an episode of unstable angina pectoris. Upon hospitalization for acute coronary syndrome analyses wereperformed to assess the degree of systemic inflammation evaluating plasma concentration of pro- and anti-inflammatorymarkers (CRP, fibrinogen, IL-6, -8, -10, TNF-?), as well as blood glucose and glycated haemoglobin HbA1c. Results. TNF-? and IL-6 levels were significantly higher in patients with unfavorable prognosis (

Factors associated with in-hospital mortality after coronary artery bypass grafting in patients with CHD and type 2 diabetes

Coronary artery bypass grafting (CABG) is the main method used for myocardial revascularisation in patients with diabetes mellitus (DM), and determining the factors affecting the outcomes of CABG in these patients is important. Objective. To identify risk factors for in-hospital mortality after coronary artery surgery (CABG) for patients with and without type 2 diabetes mellitus (T2DM). Methods. A retrospective analysis of the medical records of patients who underwent CABG from 2006 to 2009 was conducted. From these, 317 patients with T2DM were selected (median age: 59,0 years). As a control group, 350 patients (median age: 58,0 years) without diabetes or pre-diabetes, who were matched by sex, age and CABG characteristics, were selected. Logistic regression models were used to identify factors possibly associated with in-hospital mortality. Results. There were no group differences for the frequency of postoperative complications and in-hospital mortality (p >0,05). During the early postoperative period, 5 (1,6%) diabetic and 7 (2,0%) non-diabetic patients died (p=0,682). By the logistic regression analysis, T2DM did not predict patient mortality (p=0,458). Among the patients with T2DM, a risk of death was associated with a stroke history (OR 21,661; 95% CI 1,701-76,521; р=0,013), and a decreased glomerular filtration rate (GFR) as estimated by the CKD-EPI equation (OR 1,512 per 5 ml/min/1,73m2.  decrease; 95% CI 1,017-2,257; р=0,048), independent of gender, age or triple-vessel and left-main disease. By multivariate analysis for the non-diabetic patients, the risk of death increased by more than 10 times because of reinfarction (OR=10,272; 95% CI: 1,258?56,163; p=0,029) and increased by 6,8 times with an increase in preoperative fibrinogen levels of 1 g/l (OR=6,802; 95% CI: 1,283?35,714; p=0,024), independent of gender, age, smoking or mitral valve regurgitation. Conclusions. T2DM was not a predictor of death during the early period after CABG. For the diabetic patients, independent predictors of in-hospital mortality after CABG were stroke history and reduced GFR. For the patients without T2DM, the independent predictors were reinfarction and preoperative fibrinogen levels

Role of plasminogen activator inhibitor and free fatty acids in diagnosis of insulin resistance in patients with myocardial infarction

Aim. Evaluation of the dynamics of the markers of insulin resistance in patients with myocardial infarction with ST-segment elevation with andwithout type 2 diabetes mellitus in the acute and early recovery period of the disease. Materials and methods. The study included 95 patients with myocardial infarction and 60 patients with myocardial infarction and type 2 diabetes.The control group consisted of 30 persons. We all studied at 1 st and 12 th day of myocardial infarction was determined by the content of free fattyacids, glucose, C-peptide, insulin in serum and plasminogen activator inhibitor in blood plasma. In addition, the 12 th day was determined postprandialglycemic, insulin and C-peptide 2h after a standard carbohydrate breakfast. Results. It is established that during myocardial infarction accompanied by the development of insulin resistance, characterized by postprandialglycemia and insulinemia, as well as the presence of elevated levels of free fatty acids, plasminogen activator inhibitor. Conclusion. The definition of metabolic markers of insulin resistance may be of great predictive capacity for assessing the risk of both acute coronaryevents and select tactics to further treatmen