Transcript No Slide Title

OFF PUMP CORONARY ARTERY
BYPASS AT UNIVERSITAS HOSPITAL
Dr W De Vries.
DEPARTMENT CARDIOTHORACIC SURGERY
INTRODUCTION
For the past 3 decades
Conventional Coronary
artery bypass- With heart
lung machine has been
the golden standard
INTRODUCTION
SIRS
GLOBAL ISCHEMIA
INTRODUCTION
INTRODUCTION
INTRODUCTION
INTRODUCTION
INTRODUCTION
Pericardial Traction
Stitch
LIMA
Snares
LIMA
Anstomosis
OPCAB
AIM
- What is the mortality and morbidity compared to CABG
- Is the procedure feasible at our unit
OPCAB
AIM
- What is the mortality and morbidity compared to CABG
- Is the procedure feasible at our unit
Methods
- 3 Year period , records of patients were
prospectively entered in a database , according
to the criteria of the STS
OPCAB
AIM
- What is the mortality and morbidity compared to CABG
- Is the procedure feasible at our unit
Methods
- 3 Year period , records of patients were
prospectively entered in a database , according
to the criteria of the STS
Total 809 patients - OPCAB(104) - CABG(705)
Patient Characteristics
OBCAB(%)
N= 104
Age
CABG(%)
N=705
P
60.4(35-82)
60(24-84)
>70
31 (29.8%)
153 (21%)
0,06
50-69
60 (57,6%)
467 (66%)
0,08
<50
19 (18,2%)
119 (16,8%)
0,72
35 (33,6%)
181 (25,6%)
0,08
GENDER
Female
Patient Characteristics
OPCAB(104)
Smoking
Diabetes
Previous CVA
Renal Failure
Obesity
COPD
N
%
CABG(704)
N
%
P
57
16
6
9
4
12
54.8%
15,3%
5,7%
8,6%
3,8%
11,5%
417
134
61
29
44
48
59,1%
19%
8,6%
4,1%
6,2%
0,9%
0,46
0,37
0,31
0,04
0,33
0,08
NYHA III or IV
CCS III or IV
35
40
33,6%
38,4%
263
393
37,3%
0,47
55,7% 0,0009
Previous MI
57
54,8%
415
58,8%
0,85
Angina
Stable
Unstable
Asymptomatic
27
68
9
25,9%
65,3%
8,6%
171
450
82
24,5%
63.8%
11,6%
0,75
0,75
0,35
Previous Interventions
OPCAB
Procedures
CABG
First Operation
Reop # 1
Reop # 2
Reop # 3
Unknown
Total
N=104
95
7
0
1
1
CABG
%
91,3
6,7
0,0
0,9
0.9
104
N=705
641
51
2
4
7
%
P
90,9
7,2
0,2
0,5
0,9
0,88
0,83
0,28
0,63
0,87
705
Previous Stent
10
9,6
27
3,8
0,08
Previous PTCA
6
5,7
56
7,9
0,43
Vessels Affected
OPCAB(104)
Single
Double
Triple
Left Main
Unkown
N
19
50
32
13
3
%
18%
48%
30%
12.5%
2.8%
CABG(705)
N
34
145
467
87
57
%
4.8%
23%
66%
12.3%
8.0%
P
0.0002
0.0001
0.0001
0.96
0.05
Vessels Done
OPCAB(104)
No Dist Anast
6
5
4
3
2
1
LIMA
Single
Double
None
Radial
N
%
2,1 (1-5)
0
0%
1 0,9%
8 12.5%
21 2.8%
50 48%
20 19,2%
78
2
21
4
75%
1,9%
20%
3,8%
CABG(705)
P
N
3,1
1
35
197
277
115
23
%
(1-6)
0,14%
4,9%
27.9%
39,2%
16,3%
3,2%
0,0001
0.11
0.06
<0,00
<0,006
<0,001
<0,001
422
54
88
3
59%
7,6%
26%
0,4%
0,03
0,03
0,15
<0,004
Aortic Balloonpump
OPCAB
Indications
N=104
CABG
%
N=705
%
P
Low CO (preop)
LowCo (postop)
PTCA Supp
Unstable Angina
Prophylactic
0
0
0
12
1
0
0
0
11
0,9
15
8
3
77
8
2.1
1.1
0.4
10
1.1
0.34
0.87
0.46
0.85
0.87
Total
13
12,5
103
14,6
0.87
RESULTS
OPCAB(104)
N
Bloodloss
377
Bloodloss > 500 ml
30
Blood transfusion
39
NEUROLOGICAL
Disorientation
1
Permanent Stroke
1
Transient ischemic
0
RYTHM
atrium fibrillation
9
Block
0
Ventricular extrasystoles
2
%
CABG(704)
N
%
P
28,8%
37,5%
478
205
348
29,0%
49,3%
0,99
0,94
0,002
0,9%
0,9%
0
7
15
4
0,9%
2,1%
0,56%
0,72
0,36
0,49
8,6%
0%
1,9%
110
2
17
15,6%
0,2%
2,4%
0,06
0,25
0,75
Reoperation
Reason reop - Graft occ
3
1
2,8%
0,9
17
2
2,4%
0,2%
0,77
0,28
Post myocardial infarction
2
1,9%
4
0,5%
0,13
Mortality
3
0,9%
29
4,1%
0,11
Results …..Inotropes
OPCAB
N=104
Indications
Inotropic support
No Inotropic support
Unknown
Dopamine < 5ug/kg
Dopamine 5 -10 ug/kg
Dopamine > 10 ug/kg
Phenylephrine
Adrenaline
Antiarrhytmic
71
30
3
41
24
0
3
4
1
CABG
%
68,2%
28.8%
2.8%
38%
23%
0%
2.8%
3.8%
0.9%
N=705
655
11
39
201
431
2
98
57
37
%
P
92% <0,001
1.5% <0.001
5.5%
0.25
28.5%
0.02
61.1%
0.01
0.01%
0.28
13.9%
0.001
8.0%
0.12
5.2%
0.05
RESULTS Cont….
OPCAB(104)
N
RENAL
New Failure
Ventilation > 5 days
Pneumonia
Lengthy pleural drainage
Chylothorax
ARDS
Sternum Dehicence
ICU
<2 days
2- 5 days
6-10 days
> 10 days
Hospital
<5days
5-10 days
> 10 days
CABG(704)
%
P
%
N
1
1
2
3
1
0
8
0,9%
0,9%
1,9%
2,8%
0,9%
0
5,7%
3
14
1
16
0
4
16
34
60
3
2
32%
57%
2,8%
1,9%
19
584
13
8
2,4% <0,001
82% <0,001
1,8%
0,47
1,1%
0,46
15
78
17
14,4%
75%
16,3%
48
583
110
0,5%
82%
4,1%
0,4%
1,9%
0,1%
2,6%
0%
0,56%
2,2%
0,46
0,46
0,006
0,69
0,11
0,63
0,03
0,006
0,05
0,85
Conclusion
OPCAB is a feasable procedure in our Unit , our learning
curve was not steep . The Morbidity was the same in the two
groups with a tendencay towards a lower mortality in the
OPCAB patients.
 Less use of blood and bloodproducts
 Shorther ICU and Hospital Stay
Less Inotropic Support (Less Myocardial Damage)
Less SIRS
 Cost - Reduction of R20,000 / patient
Diabetes as a risk factor in cardiac surgery
 Aim
- What is the mortality and morbidity
- Is Diabetes a risk factor (only 2/7 risk scores)
Slide Sourc e:
Lipids Online
www. lipidsonline.org
Procedures(n=852)
Procedure
Number
Age
Diabetes
Male
Female
AVR
73
63(51-75)
3
44
29
Aortic Root
3
73(67-81)
0
3
0
1
47(47-47)
0
1
0
AVR + VSD
2
30(30-30)
0
2
0
MVR
64
38(51-62)
1
21
43
Mitral Valve Repair
48
33(14-65)
1
15
33
DVR
73
41(20-78)
2
36
37
DVR + LV aneurysm
2
56(46-67)
1
2
0
TVR
Slide Source:
Lipids Online
www.lipidsonline.org
Procedures(n=852)
Procedure
Number
Age
Diabetes
Male
Female
AVR
73
63(51-75)
3
44
29
Aortic Root
3
73(67-81)
0
3
0
1
47(47-47)
0
1
0
AVR + VSD
2
30(30-30)
0
2
0
MVR
64
38(51-62)
1
21
43
Mitral Valve Repair
48
33(14-65)
1
15
33
DVR
73
41(20-78)
2
36
37
DVR + LV aneurysm
2
56(46-67)
1
2
0
TVR
Slide Source:
Lipids Online
www.lipidsonline.org
Procedures(n=852)
Procedure
Number
Age
Diabetes
546
66(24-84)
113
CABG + ASD
2
52(48-56)
CABG +VSD
1
CABG + AVR
Male
Female
401
45
0
1
1
67(67-69)
1
1
0
10
66(51-74)
2
5
5
CABG + MVR
9
58(50-77)
0
16
3
CABG + DVR
16
64(64-64)
3
1
0
CABG (Offpump)
17
67(46-77)
1
12
5
CABG
TOTAL
853
125
Slide Source:
Lipids Online
www.lipidsonline.org
Diabetes as a risk factor in cardiac surgery
 Aim
- What is the mortality and morbidity
- Is Diabetes a risk factor (only 2/7 risk scores)
Slide Source:
Lipids Online
www.lipidsonline.org
Procedures(n=852)
Procedure
Number
Age
Diabetes
Male
Female
AVR
73
63(51-75)
3
44
29
Aortic Root
3
73(67-81)
0
3
0
1
47(47-47)
0
1
0
AVR + VSD
2
30(30-30)
0
2
0
MVR
64
38(51-62)
1
21
43
Mitral Valve Repair
48
33(14-65)
1
15
33
DVR
73
41(20-78)
2
36
37
DVR + LV aneurysm
2
56(46-67)
1
2
0
TVR
Slide Source:
Lipids Online
www.lipidsonline.org
Procedures(n=852)
Procedure
Number
Age
Diabetes
546
66(24-84)
113
CABG + ASD
2
52(48-56)
CABG +VSD
1
CABG + AVR
Male
Female
401
45
0
1
1
67(67-69)
1
1
0
10
66(51-74)
2
5
5
CABG + MVR
9
58(50-77)
0
16
3
CABG + DVR
16
64(64-64)
3
1
0
CABG (Offpump)
17
67(46-77)
1
12
5
CABG
TOTAL
853
125
Slide Source:
Lipids Online
www.lipidsonline.org
Mortality
Diabetics (125)
N
%
10
8%
Nondiabetics (727)
N
32
%
4.4%
Slide Sourc e:
Lipids Online
www. lipidsonline.org
Diabetes as a risk factor in cardiac surgery
 Aim
- What is the mortality and morbidity
- Is Diabetes a risk factor (only 2/7 risk scores)
Slide Source:
Lipids Online
www.lipidsonline.org
Diabetes as a risk factor in cardiac surgery
 Aim
- What is the mortality and morbidity
- Is Diabetes a risk factor (only 2/7 risk scores)
Methods
- 852 patiens were studied
- Retrospective.
- Computerized Database
Slide Sourc e:
Lipids Online
www. lipidsonline.org
Beyond Cholesterol: Predicting
Cardiovascular Risk In the 21st Century
Cardiovascular
Cardiovascular Risk
Risk
Lipids
Lipids
HTN
HTN
Diabetes
Diabetes
Behavioral
Behavioral
Hemostatic
Hemostatic
Thrombotic
Thrombotic
Inflammatory
Inflammatory
Genetic
Genetic
Slide Source:
Lipids Online
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Mortality in People with Diabetes
Causes of Death
50
% of Deaths
40
30
20
10
0
Ischemic Other Diabetes Cancer Stroke Infection Other
heart
heart
disease disease
Geiss LS et al. In: Diabetes in America. 2nd ed. 1995; chap 11.
Slide Source:
Lipids Online
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Hospitalization Costs for Chronic
Complications of Diabetes in the US
Ophthalmic Others
disease
Renal
disease
Neurologic
disease
Peripheral
vascular
disease
 Total costs 12
billion US $
 CVD accounts
for 64% of
total costs
Cardiovascular
disease
American Diabetes Association. Economic Consequences of Diabetes Mellitus
in the US in 1997. Alexandria, VA: American Diabetes Association, 1998:1-14.
Slide Source:
Lipids Online
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Diabetes Increases Risk of Coronary Plaque
Disruption and Thrombosis
Cause of Myocardial Infarction
Platelet Aggregation
F VII
Fibrinogen
F VIII
vWF
Coronary Artery
Thrombus
Plaque
Formation
Plaque
Disruption
Sympathetic Tone
PAI-1
TPA
PGI2
Slide Source:
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Survival Post-MI in Diabetic and Nondiabetic
Men and Women: Minnesota Heart Survey
100
MEN
WOMEN
100
80
60
40
0
0
n=1628
Diabetes
n=228
20 40 60
80
Months Post-MI
No diabetes
Survival (%)
Survival (%)
No diabetes
80
n=568
60
Diabetes
40
0
0
n=156
20 40
60
80
Months Post-MI
Adapted from Sprafka JM et al. Diabetes Care 1991;14:537-543.
Slide Source:
Lipids Online
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Age-adjusted CVD death rate
per 10,000 person-years
Influence of Multiple Risk Factors* on CVD
Death Rates in Diabetic and Nondiabetic Men:
MRFIT Screenees
140
120
No diabetes
Diabetes
100
80
60
40
20
0
None
One only
Two only
*Serum cholesterol >200 mg/dl, smoking, SBP >120 mmHg
Stamler J et al. Diabetes Care 1993;16:434-444
All three
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Putative Mechanism for Increased
Atherosclerosis in Type 2 Diabetes
BLACK BOX
 Dyslipidemia
 Hypertension
 Hyperinsulinemia/insulin resistance
 Hemostatic abnormalities
 Hyperglycemia
 AGE proteins
 Oxidative stress
AGE = advanced glycation end products
Adapted from Bierman EL. Arterioscler Thromb 1992;12:647-656.
Slide Source:
Lipids Online
www.lipids online.org
Interrelation Between Atherosclerosis
and Insulin Resistance
Hypertension
Obesity
Hyperinsulinemia
Insulin
Insulin
Resistance
Resistance
Diabetes
Hypertriglyceridemia
Atherosclerosis
Atherosclerosis
Small, dense LDL
Low HDL
Hypercoagulability
Slide Source:
Lipids Online
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Strategies for Reduction of Diabetic
Complications
 Microvascular complications
- Aggressive screening
- Improved metabolic control
 Macrovascular complications
- Improved glycemic control (positive but minor)
- Prevention of type 2 diabetes
- Aggressive treatment of established CVRF in
diabetic and possibly prediabetic subjects
- Diabetic agents that improve cardiovascular risk
Slide Source:
Lipids Online
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Indications for Cardiac Testing in
Diabetic Patients
 Typical or atypical cardiac symptoms
 Resting ECG suggestive of ischemia or infarction
 Peripheral or carotid occlusive arterial disease
 Sedentary lifestyle or plan to begin a vigorous exercise program
 Two or more of the risk factors listed below
- Total cholesterol >240 mg/dL, LDL cholesterol >160 mg/dL, or HDL
cholesterol <35 mg/dL
- Blood pressure >140/90 mmHg
- Smoking
- Family history of premature CAD
- Positive micro/macroalbuminuria
Slide Source:
Lipids Online
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Overall 5-Year Mortality in the Bypass Angioplasty
Revascularization Investigation (BARI-1)
1.0
DM-PTCA
Mortality
0.8
DM-CABG
Non DM-CABG
0.6
Non DM-PTCA
0.4
0.25
0.18
0.08
0.07
0.2
0.0
0
1
2
3
Follow-up (years)
Detre KM et al. N Engl J Med 2000;342:989-997.
4
5
Slide Source:
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Impact of PTCA vs. CABG on Mortality
in BARI-1
Mortality in Patients
without Q-MI
1.0
DM-CABG
0.8
Non DM-CABG
Non DM-PTCA
0.6
Mortality
Mortality
1.0
DM-PTCA
0.8
0.4
0.79
0.6
0.4
0.29
0.27
0.22 0.2
0.16
0.07
0.06
0.2
0.0
Mortality in Patients
After Q-MI
0
1
2
3
4
Follow-up (years)
5
0.0
Detre KM et al. N Engl J Med 2000;342:989-997.
0.17
0
1
2
3
4
Years after Q-MI
5
Slide Source:
Lipids Online
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Eight-Year Mortality in Emory Angioplasty vs Surgery
Trial (EAST)
All EAST Patients
% Survival
100
80
60
40
CABG (n=194)
20
PTCA (n=198)
0
0
1
2
4
5
60
40
CABG (n=30)
20
PTCA (n=29)
0
1
2
3
4
p = 0.23
5
6
6
100
% Survival
80
0
3
p = 0.40
Treated Diabetic Patients
100
% Survival
82.7
79.3
7
8
Patients without Diabetes
80
60
40
CABG (n=164)
20
PTCA (n=169)
0
7 8
0 1 2
Years after Randomization
King SB III et al. J Am Coll Cardiol 2000;35:1116-1121.
3
4
p = 0.71
5
6
7
Slide Source:
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8
6-Month Angiographic Outcome after PTCA
in Diabetes (377 Patients with 476 Lesions)
Total Occlusion
100
100
75
75
62%
50
49%
25
Restenosis
(n = 237)
Total
Occlusion
(n = 60)
Patients (%)
Lesions (%)
Overall Restenosis Rate
50
37%
25%
25
11%
0
13%
0
Angiographic FU = 6 months
Van Belle E et al. J Am Coll Cardiol 1999;34:476-485.
1 Site
2 Sites
3 Sites
PTCA Site(s)
Slide Source:
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Effect of Stents on Target Vessel
Revascularization (TVR) after PTCA in Diabetes
Proportion Free of TVR
1.00
p = 0.021
df = 3, Log-rank Test
0.95
0.90
0.85
1997
0.80
Year
0.75
0.70
0
0
N % Stent
1994 305
17.4
1995 425
24.9
1996 480
41.0
1997 288
55.5
2
1996
1995
1994
4
6
8
10
12
Months Post PTCA
Rankin JM et al. Circulation 1998;98:I-79.
Slide Source:
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Patients with Diabetes
(n = 491)
20
Stent + Placebo
Stent + Abciximab
Angioplasty + Abciximab
15
18.4%
16.6%
10
8.1%
5
0
0
30
60
90
120 150 180
Incidence of repeated TVR
at 6 mos. (%)
Incidence of repeated TVR
at 6 mos. (%)
Evaluation of Platelet IIb
IIb/
/IIIa Inhibitor for Stenting
Trial (EPISTENT): Benefit of Abciximab and Stenting in
Diabetes on Reducing TVR
Days after Randomization
Lincoff AM et al. N Engl J Med 1999;341:319-327.
Patients without Diabetes
(n = 1908)
20
Stent + Placebo
Stent + Abciximab
Angioplasty + Abciximab
15
14.6%
9.0%
10
8.8%
5
0
0
30
60
90
120 150 180
Days after Randomization
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Lipids Online
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Diabetes as a risk factor in cardiac surgery
852 patients
2 Year Period
Slide Source:
Lipids Online
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Diabetes as a risk factor in cardiac surgery
852 patients
2 Year Period
125 Diabetic patients (14%)
Slide Source:
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Type of Diabetes(n=125 )
Oral
Insulien
82(65%)
34(27%)
Diet
8(6%)
None
1(0.8%)
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Percentage %
Type of Diabetes(n=125 )
100
90
80
70
60
50
40
30
20
10
0
N=82
Oral
Insulin
Diet
N=27
N=8
None
N=1
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Procedures(n=852)
Procedure
Number
Age
Diabetes
Male
Female
AVR
73
63(51-75)
3
44
29
Aortic Root
3
73(67-81)
0
3
0
1
47(47-47)
0
1
0
AVR + VSD
2
30(30-30)
0
2
0
MVR
64
38(51-62)
1
21
43
Mitral Valve Repair
48
33(14-65)
1
15
33
DVR
73
41(20-78)
2
36
37
DVR + LV aneurysm
2
56(46-67)
1
2
0
TVR
Slide Source:
Lipids Online
www.lipidsonline.org
Procedures(n=852)
Procedure
Number
Age
Diabetes
546
66(24-84)
113
CABG + ASD
2
52(48-56)
CABG +VSD
1
CABG + AVR
Male
Female
401
45
0
1
1
67(67-69)
1
1
0
10
66(51-74)
2
5
5
CABG + MVR
9
58(50-77)
0
16
3
CABG + DVR
16
64(64-64)
3
1
0
CABG (Offpump)
17
67(46-77)
1
12
5
CABG
TOTAL
853
125
Slide Source:
Lipids Online
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Diabetes as a risk factor in cardiac surgery
 588 procedure
CABG related-118(20%)
 264 procedure
Valve related-7(2.6%)
Slide Source:
Lipids Online
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Risk Factors
Diabetics(125)
N
%
Smoking
60
Previous CVA
Nondiabetics(727)
N
%
48%
327
44%
14
11%
81
11%
Renal insuff
12
9.6%
26
3.5%
Elevated Cholesterol
46
36%
151
25%
Hypertension
70
56%
235
32%
Slide Source:
Lipids Online
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Previous Interventions
Diabetics
Diabetics
N=125
Procedures
CABG
PTCA
Stents
Thrombolysis
Other Noncardiac
Other Cardiac
Valve Replacement
Valve Repair
Total
%
NonDiabetics
N=727
%
13
9
7
3
2
10.4
7.2
5.6
2.4
1.6
59
45
24
16
7
8
6.1
3.3
2.2
0.9
6
2
0
4.8
0.8
0
11
30
22
1.5
4.1
3.0
42
33
194
26.6
Slide Sourc e:
Lipids Online
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Angina
Diabetics(121)
Nondiabetics(470)
N
%
N
%
Assymptomatic
12
10%
38
8.8%
Stable
30
25%
114
24.2%
Unstable
79
65%
307
65.3%
Slide Source:
Lipids Online
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Myocardial Infarction(Preop
Infarction(Preop))
Nondiabetics(470)
Diabetics(118)
N
%
49
41%
201
42.7%
Subendocardial
9
7%
54
11%
Unknown
2
1%
7
1.4%
60
51%
265
54.4%
Transmural
Total
N
%
Slide Source:
Lipids Online
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Arrhythmia(Preop
Arrhythmia(
Preop))
Diabetics(125)
Nondiabetics(727)
N
%
N
%
Atrium Fibrillation
4
36%
71
71%
Ventricilar Ectrasystoles
3
27%
17
17%
Block
4
36%
22
22%
Total
11
8.8%
100
13%
Slide Source:
Lipids Online
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Cardiac Function
Diabetics (125)
N
CABG
Valves
Nondiabetics (727)
%
N
%
118 50(17-80)
470
50(35-85)
7 68(60-76)
257
57(36-82)
Slide Sourc e:
Lipids Online
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Duration of operation
Diabetics(125)
Non-Diabetics(727)
Crossclamptime(min)
60(0-124)
67(0-198)
Perfusiontime(min)
108(0-200)
107(0-298)
Slide Source:
Lipids Online
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Aortic Balloonpump
N=720
CABG
N=120
Indications
Low CO (preop)
Low CO (itraop)
LowCo (postop)
Cardiac Shock
Unstable Angina
Prohylactic
Unkown
Total
CABG
%
%
6
2
1
1
8
28.5
9.5
4.7
4.7
38
11
2
2
2
41
12.9
2.3
2.3
2.3
48.2
0
3
0
14
6
18
7
21
21
17.5
85
11.8
Slide Sourc e:
Lipids Online
www. lipidsonline.org
Pacing (Intraoperative
(Intraoperative))
Diabetics (125)
N
CABG
6
Nondiabetics (727)
%
N
4.8
34
%
4.6
Slide Sourc e:
Lipids Online
www. lipidsonline.org
Vessels Affected
Diabetics (118)
Nondiabetics (470)
N
%
Single
7
5.9%
32
6.8%
Double
28
23.7%
108
22.9%
Triple
80
67.7%
314
66.8%
Left Main
13
11%
68
14.4%
3
2.5%
16
3.4%
Unkown
N
%
Slide Sourc e:
Lipids Online
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Inotropes
Diabetics
Diabetics
N=120
%
Indications
Preoperative
Postoperative
None
Dopamine < 5ug/kg
Dopamine 5 -10 ug/kg
Dopamine > 10 ug/kg
Phenylephrine
Adrenaline
NonDiabetics
5
4.1%
1
41
8
0.83%
0
24
15
N=727
%
17
2.3%
0
38% 246
6.6% 41
0%
33%
5.6%
0%
3
20% 116
0.41%
15%
4.1%
64
8.8%
Slide Sourc e:
Lipids Online
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Complications
Renal
Diabetics
Nondiabetics
(125)
(727)
Elevated Urea /Createnine 5(4%)
10(1.3%)
Renal Failure
3(2.9%)
16(2.2%)
Dialysis
2(1.6%)
1(1.2%)
Total
10(8%)
22(3%)
Mortality
6(4.8%)
12(1.6%)
Slide Source:
Lipids Online
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Complications
Infection
Diabetics
Nondiabetics
(125)
(727)
Deepsternal infection **
2(1.6%)
2(0.275%)
Suoerficial sternal infection
2(1.6%)
2(0.275%)
Septecemia *
2(1.6%)
0(0%)
Leg infections
2(1.6%)
1 (0.13%)
Total
8(6.4%)
5(0.68%)
Mortality
3(2.4%)
0(0%)
* Mortality.
Slide Source:
Lipids Online
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Complications
Neurological
Diabetics
Nondiabetics
(125)
(727)
Stroke Permanent
5(4%)
11(1.5%)
Stroke Transient
0(0%)
5(0.68%)
Depressed Conscious
(0%)
1(0.13%)
Disorientated
0(0%)
6 (0.82%)
Convullsions
0(0%)
1(0.13%)
Total
5(4%)
21(1.8%)
Mortality
1(0.8%)
3(0.4%)
Slide Source:
Lipids Online
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Mortality in Nondiabetics
N = 727
Vasc
(%)
Infection
2
Cardiac
17
Infection
(6.2%) Neurol
3%
(53%)
Other 6%
Renal
4
(12.5%) Renal
Pulmonary
4
(12.5%)
Vascular
1
(3.1%)
Neuro
2
(6.2%)
Other
2
(6.2%)
Mortality (32/727)
32
(4,4%)
Pulm
12%
53%
Cardiac
Slide Source:
Lipids Online
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Mortality in Diabetics
N = 125
(%)
Infection
2
(20%)
Cardiac
3
(30%)
Renal
1
(10%)
Pulmonary
1
(10%)
Vascular
1
(10%)
Neuro
1
(10%)
Other
1
(10%)
Mortality (10/125)
10
(8%)
Pulm
Vasc
10%
10%
Infection
20%
10%
Other
10%
30%
10%
Neurol
Cardiac
Renal
Slide Source:
Lipids Online
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Mortality
Diabetics(125)
N
%
10
8%
Nondiabetics(727)
N
32
%
4.4%
Slide Source:
Lipids Online
www.lipidsonline.org
Conclusions
In patients with diabetes mellitus, the morrtality and morbidity
remains high: The following is significant higher than in
Nondiabetics
 Infection 6 times higher
 Renal failure 3 times higher
 Neurological complications 4 times higher
 Mortality 2 times higher
Slide Source:
Lipids Online
www.lipids online.org
Conclusion
 Most deaths in the diabetics are due to cardiac
causes and infection. In the nondiabetics most are
due to cardiac causes
 Patients with diabetes are a high risk group.
Slide Source:
Lipids Online
www. lipidsonline.org