Volume 4, Number 2, June 2007

Only a minority of patients referred for elective coronary artery bypass surgery have risk factors diagnosed and treated according to established guidelines
Russell E Anderson, Kerstin Brismar, Torbjörn Ivert

Patients deserve to be medically optimised for treatment of metabolic risk factors and hypertension before referral for elective coronary artery bypass grafting (CABG). We describe here a prospective study of 347 consecutive patients referred for elective CABG. An oral glucose tolerance test (OGTT) was performed and metabolic risk factors and hypertension were determined pre-operatively. Compliance to treatment guidelines was calculated.
From the total of 347 patients, 80 patients (23%) had known and 66 (19%) had previously unknown diabetes. Dysglycaemia (that is, diabetes and pre-diabetes) was found in 194 (73%) of the 267 patients without known diabetes. Among patients with dysglycaemia, 111/274 (41%) received one antihypertensive medication, or none, and blood pressure guidelines were met in 39/274 (14%); statins were being taken by 206 (75%; average dose 23 mg simvastatin) and low-density lipoprotein (LDL)-cholesterol guidelines were met in 43 (16%).
In conclusion, diabetes diagnosis and titration of risk factor treatment to guidelines is inadequate even in elective CABG patients. A pre-admission OGTT affords an opportunity to improve care significantly.

Diabetes Vasc Dis Res 2007;4:112-116.

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