La chirurgie du pontage aorto coronaire chez les diabétiques : Résultats immédiats et à moyen terme
Mots-clés :
Pontage aorto coronaire, diabète.Résumé
Prérequis : Le diabète est classiquement considéré comme un facteur aggravant le pronostic après une chirurgie de pontage aortocoronaire. Des études récentes suggèrent une amélioration du pronostic des coronariens diabétiques bénéficiant d’une revascularisation chirurgicale, néanmoins l’impact direct du diabète sur la morbimortalité reste mal élucidé.But : Etudier le pronostic à court et à moyen terme des patients diabétiques après une chirurgie de pontage aorto coronaire.
Méthodes : Etude rétrospective ayant intéressé 228 patients revascularisés par pontage aorto coronaire entre 2005 et 2010 et repartis en deux groupes : cent vingt six patients diabétiques et 102 patients non diabétiques. Le groupe de diabétiques comportait plus de femmes (27% Vs 12,7% P=0,009), moins de tabagiques (55,6% Vs 80,4% P<0,0001) et plus de patients tri tronculaires (67,5% Vs 42,2% P=0,005).
Résultats : La mortalité hospitalière était significativement plus élevée chez les diabétiques (16% Vs 4,1% P=0,005) avec un séjour en réanimation plus prolongé (2,3 jours Vs 2,1 jours P=0,048). Le taux de médiastinites post opératoires n'était par contre pas influencé par le diabète (2% Vs 3,2% P=0,69) même en cas d'utilisation de deux artères mammaires.Au bout d'un suivi moyen de 28 mois, la survie des diabétiques était significativement inférieure par rapport au groupe contrôle (91% Vs 99% p<0.001). La survie sans évènements cardiovasculaires majeurs était par contre comparable (76% Vs 80% p=0. 82).
Conclusion : Le diabète aggrave le pronostic immédiat et à moyen terme après une chirurgie de pontage aorto coronaire.
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Références
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