RESUMO
AIM: to determine risk factors of early cardiovascular complications after beating-heart coronary artery bypass grafting (CABG) in patients with ischemic coronary disease (IHD) and type two diabetes (D2). MATERIALS AND METHODS: We included into this study 188 patients (mean age 59 years, 85.1% men) with IHD and D2 who underwent off-pump CABG. The following cardiovascular complications (CVC) registered within 7 days after surgery were analyzed: myocardial infarction (MI), stroke/transient ischemic attack (S/TIA), atrial fibrillation (AF). The control group of patients without CVC was formed by case-control method. In the study groups we compared IHD severity, coronary angiography, brachiocephalic and peripheral arteries duplex ultrasonography data, blood pressure level, glomerular filtration rate, EuroSCORE II risk, preoperative glycemic parameters and hypoglycemic therapy, as well as CABG volume and severity. Factors associated with postoperative CVC were determined by multiple stepwise logistic regression. RESULTS AND CONCLUSIONS: CVC were registered in 47 patients (MI - in 18, S/TIA - in 2, AF - in 27). As compared with the control group patients with CVC had higher Canadian Cardiovascular Society angina class and EuroSCORE II risk, lower left ventricular ejection fraction and glomerular filtration rate; they more frequently had left main coronary artery involvement, total coronary artery occlusions, carotid and peripheral artery disease. Group of patients with CVC had higher levels of glycosylated hemoglobin, serum glucose and its diurnal variability, as well as higher proportion of patients switched preoperatively from oral hypoglycemic agents to rapid-acting insulin. According to logistic regression most informative predictors of CVC were peripheral artery disease (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-7.1), diurnal serum glucose variability on admission day (OR 13.2, 95% CI 5.9-30.0 per 0.1 mmol/l) and the day before surgery (OR 1.3, 95%CI 1.2-2.4 per 0.1 mmol/l), and switching from oral hypoglycemic agents to insulin (OR 2.5, 95%CI 1.2-5.5).
