CORONARY-ARTERY BYPASS-SURGERY IN THE DIABETIC PATIENT

Coronary artery and peripheral occlusive arterial disease frequently c omplicate diabetes mellitus, with death due to atherosclerotic coronar y artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 mat ched controls who underwent coronary artery bypass (CABG) is studied a nd their early and late postoperative outcomes are described. The mean age was 61 +/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a me an duration of diabetes of 8.5 years (range 2 months - 35 years). The median number of grafts per patient performed in the diabetic group an d the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates wer e encountered in teh diabetic group suffered inrreversible acute tubul ar necrosis and became dialysis dependent post-operatively. Longterm f ollow-up showed no longterm mortality in either group, with full relie f of angina achieved in 75% of diabetic patients compared with 87.7% o f matched controls. In addiction diabetic patients suffered longterm c ardiac morbidity than the control group (21.8% versus 12.5%). The resu lts of this study suggest that CABG is a safe operation for the diabet ic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.