Document Detail


The impact of diabetic retinopathy on long-term outcome following coronary artery bypass graft surgery.
MedLine Citation:
PMID:  12142107     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to assess the impact of diabetic retinopathy on long-term outcome among patients with diabetes and multivessel coronary artery disease (MVD) following coronary artery bypass graft surgery (CABG). BACKGROUND: For diabetics, CABG is the preferred revascularization strategy. Diabetic retinopathy is a major microvascular complication of diabetes, and its severity is directly related to total glycemic exposure. METHODS: We identified 223 consecutive diabetics with MVD whose retinae were evaluated within one year prior to CABG. The most recent ophthalmologic records up until the time of CABG were used to evaluate the severity of retinopathy. The median follow-up after CABG was 11.6 years. RESULTS: Diabetic retinopathy was a strong independent predictor of overall mortality (relative risk [RR], 4.0), and repeat revascularization (RR, 3.0). In separate analyses of diabetics with retinopathy and without retinopathy, predictors of mortality differed significantly between the two groups. Among diabetics with retinopathy, the presence of either preoperative renal (RR, 2.5) or ventricular (RR, 2.0) dysfunction had unfavorable effects on mortality, but the survival curves did not differ significantly according to the presence or absence of internal thoracic artery (ITA) grafting. In comparison, among diabetics without retinopathy, ITA grafting (RR, 0.34) had a beneficial effect on mortality, and the survival curves varied somewhat according to the presence or absence of renal or ventricular dysfunction. CONCLUSIONS: Diabetics with retinopathy had a distinct post-CABG course with a worse long-term prognosis, as compared with diabetics without retinopathy. Retina evaluation is useful for prediction of long-term prognosis and management of diabetics who need CABG.
Authors:
Takayuki Ono; Junjiro Kobayashi; Yoshikado Sasako; K o Bando; Osamu Tagusari; Kazuo Niwaya; Hideaki Imanaka; Takeshi Nakatani; Soichiro Kitamura
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-07-26     Completed Date:  2002-08-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  428-36     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan. o-takayuki@nagoya.tokushukai.or.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass*
Coronary Artery Disease / complications,  surgery
Diabetes Mellitus, Type 2 / complications,  surgery
Diabetic Retinopathy / etiology*,  mortality
Female
Follow-Up Studies
Humans
Japan / epidemiology
Male
Mammary Arteries / transplantation
Middle Aged
Postoperative Complications / etiology,  mortality
Predictive Value of Tests
Reoperation
Severity of Illness Index
Survival Analysis
Time
Treatment Outcome
Ventricular Dysfunction, Left / complications,  surgery

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