Document Detail


Clinical characteristics associated with poor long-term survival among patients with diabetes mellitus undergoing saphenous vein graft interventions.
MedLine Citation:
PMID:  18926154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Limited data exist on the long-term outcomes among diabetic patients undergoing saphenous vein graft (SVG) interventions. Thus, the baseline clinical factors associated with long-term adverse events in these patients are less known. METHODS: Accordingly, we analyzed 1,160 consecutive patients (37.7% with diabetes) undergoing SVG interventions from the Duke Cardiovascular Disease Database (1990-2003). Cox proportional hazards modeling was used to identify predictors of long-term death in diabetic patients. The most significant model predictors were then used to construct a decision tree providing unadjusted Kaplan-Meier survival estimates at a median follow-up of 4 years. RESULTS: At median follow-up of 4 years, death (33.3% vs 18.1%, P < .0001; unadjusted hazard ratio 1.98, 95% CI 1.64-2.38) and death or myocardial infarction (49.6% vs 32.9%, unadjusted hazard ratio 1.71, 95% CI 1.462.00) were significantly higher in patients with diabetes mellitus compared with those without it. In patients with diabetes undergoing SVG interventions, a simple clinical decision algorithm, based on the most significant model predictors, demonstrated that 88% of patients without heart rate >80 beat/min, congestive heart failure, renal insufficiency, or hypertension survived after SVG intervention at median follow-up of 4 years. In contrast, none of the few patients with all these 4 factors survived at follow-up (100% mortality). CONCLUSIONS: Compared with patients without diabetes, diabetic patients undergoing SVG intervention have significantly worse long-term outcomes with one third dying at median follow-up of 4 years. We provide a simple decision tool that allows stepwise risk-stratification using baseline factors in diabetic patients undergoing SVG interventions and identify 4 risk factors associated with extremely poor long-term survival in this cohort.
Authors:
Rajendra H Mehta; Emily Honeycutt; Linda K Shaw; Michael H Sketch
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-17     Completed Date:  2008-11-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  728-35     Citation Subset:  AIM; IM    
Affiliation:
Duke University Medical Center, Durham, NC, USA. mehta007@dcri.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Comorbidity
Coronary Artery Bypass / methods,  mortality*
Decision Trees
Diabetic Angiopathies / epidemiology,  mortality*,  surgery*
Female
Heart Failure / epidemiology
Humans
Hypertension / epidemiology
Kaplan-Meiers Estimate
Male
Middle Aged
Patient Readmission / statistics & numerical data
Peripheral Vascular Diseases / epidemiology
Proportional Hazards Models
Renal Insufficiency / epidemiology
Retreatment / statistics & numerical data
Risk Assessment
Saphenous Vein / transplantation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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