Cirurgia de revascularização miocárdica no diabetes mellitus

Diabetes mellitus is present in 25­30% of patients undergoing coronary artery bypass grafts surgery. Early and late post-operative prognoses are different for the diabetic patient. Coronary artery bypass grafts are indicated in 2 or more vessel lesions, but it can also be preferred to percutaneous angioplasty in 1-vessel lesions, when this is the anterior descending artery or there is a great area under ischemia. Diabetic candidates to renal transplant must be investigated and revascularized pre-operatively, if necessary. Morbidity is greater in these patients, mainly due to respiratory, renal and cerebral complications and wound infections. Intensive care unit and hospital length of stay are more prolonged, but there is not increased early mortality. Diabetes mellitus represents an independent risk factor for late graft failure and mortality from cardiac and general causes. Although under an increased risk, coronary artery surgery results in better quality of life and late survival in the diabetic patients with severe coronary artery disease, as compared to medical treatment and percutaneous coronary angioplasty, specially in those who use insulin and when internal thoracic arterial grafts are implanted.