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Minoru Ono
Noboru Motomura
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Ann Thorac Surg 2006;81:608-612
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Impact of Diabetic Retinopathy on Cardiac Outcome After Coronary Artery Bypass Graft Surgery: Prospective Observational Study

Takayuki Ono, MD a , * , Takeki Ohashi, MD c , Teiji Asakura, MD c , Nagara Ono, MD b , Minoru Ono, MD a , Noboru Motomura, MD a , Shinichi Takamoto, MD a

a Department of Cardiothoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
b Department of Anesthesiology, The University of Tokyo Hospital, Tokyo, Japan
c Department of Cardiovascular Surgery, Heart Center, Nagoya Tokushukai General Hospital, Aichi, Japan

Accepted for publication July 18, 2005.

* Address correspondence to Dr Takayuki Ono, Department of Cardiovascular Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan (Email: takohno{at}hotmail.com).

BACKGROUND: Diabetic retinopathy is a manifestation of more severe diabetes. We sought to assess the impact of diabetic retinopathy on cardiac outcome of coronary artery bypass graft surgery (CABG).

METHODS: We prospectively assessed the status of the retina of 74 consecutive diabetics who were referred for first-time CABG, and compared cardiac outcome of CABG in diabetics with retinopathy with that in those without retinopathy. Cardiac events included recurrent angina or congestive heart failure that needed admission to hospital, myocardial infarction, repeat revascularization, and cardiac death.

RESULTS: Twenty-six diabetics had retinopathy and 48 diabetics did not have retinopathy. Diabetics with retinopathy were likely to have higher hemoglobin A1c level (p = 0.048), and receive insulin treatment (p = 0.0065). In the 12 months of follow-up, 13 cardiac events occurred in diabetics with retinopathy and 7 in those without retinopathy (p = 0.0021). Among diabetics with retinopathy, heart failure or death due to heart failure accounted for 54% (7 of 13) of these cardiac events. Kaplan-Meier analysis showed significant difference in cardiac event-free survival between the two groups (p < 0.001). After adjustment for differences in patients' characteristics, diabetic retinopathy remained a predictor of cardiac event (adjusted relative risk = 4.2, 95% confidence interval, 1.5% to 11.9%; p = 0.0067).

CONCLUSIONS: After CABG, diabetics with retinopathy have a substantially increased risk of cardiac events, especially of congestive heart failure.




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