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Clinical characteristics associated with poor long-term survival among patients with diabetes mellitus undergoing saphenous vein graft interventions.

Publication ,  Journal Article
Mehta, RH; Honeycutt, E; Shaw, LK; Sketch, MH
Published in: Am Heart J
October 2008

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.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2008

Volume

156

Issue

4

Start / End Page

728 / 735

Location

United States

Related Subject Headings

  • Saphenous Vein
  • Risk Assessment
  • Retreatment
  • Renal Insufficiency
  • Proportional Hazards Models
  • Peripheral Vascular Diseases
  • Patient Readmission
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

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ICMJE
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Mehta, R. H., Honeycutt, E., Shaw, L. K., & Sketch, M. H. (2008). Clinical characteristics associated with poor long-term survival among patients with diabetes mellitus undergoing saphenous vein graft interventions. Am Heart J, 156(4), 728–735. https://doi.org/10.1016/j.ahj.2008.05.033
Mehta, Rajendra H., Emily Honeycutt, Linda K. Shaw, and Michael H. Sketch. “Clinical characteristics associated with poor long-term survival among patients with diabetes mellitus undergoing saphenous vein graft interventions.Am Heart J 156, no. 4 (October 2008): 728–35. https://doi.org/10.1016/j.ahj.2008.05.033.
Mehta, Rajendra H., et al. “Clinical characteristics associated with poor long-term survival among patients with diabetes mellitus undergoing saphenous vein graft interventions.Am Heart J, vol. 156, no. 4, Oct. 2008, pp. 728–35. Pubmed, doi:10.1016/j.ahj.2008.05.033.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2008

Volume

156

Issue

4

Start / End Page

728 / 735

Location

United States

Related Subject Headings

  • Saphenous Vein
  • Risk Assessment
  • Retreatment
  • Renal Insufficiency
  • Proportional Hazards Models
  • Peripheral Vascular Diseases
  • Patient Readmission
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate