Background: Diabetic patients particularly benefit from CABG under elective conditions. If this benefit may also apply for diabetic patients with AMI undergoing emergency CABG remains a matter of debate.

Methods: Between 01/2001 and 12/2020, 1428 patients underwent CABG within 48hours after being diagnosed with AMI. Of those, 1072 (72%) were non-diabetic (non-DM), 149 (10%) non-insulin-dependent diabetic (NIDDM) and 206 (14%) insulin-dependent diabetic (IDDM) patients.

Results: NIDDM and IDDM patients were significantly more often female (20.1% vs 27.5% vs 32.0% , p<0.001) with a higher BMI (27.3±4.2 vs 28.94.9± and 29.8±5.6; P<0.001) and a higher EuroSCORE II (7.8 vs 11.6 vs 8.4, p<0.05). NIDDM patients were more often diagnosed with NSTEMI (71.1% vs 56.4% vs 55.8%;p<0.05). NIDDM patients had significantly longer procedure times (244.97±61.4 vs 223.6±60.0 vs 229.0±51.8 min ;p<0.01), but cross-clamp and bypass-time did not differ. Sternal wound infections occurred more often in NIDDM patients ( 4.7% vs 2.4% vs 0.9%;p<0.05). NIDDM patients had to stay longer in the ICU (71.1% vs 57.8% vs 52.9%; p<0.05) and had to be ventilated longer (47.0% vs 31.6% vs 27.8%; p<0.01). Long-term survival analysis demonstrated a significantly reduced survival of NIDDM patients compared to IDDM and non-diabetic patients (43.6% vs 58.2 vs 65.2%; p<0.01).  

Conclusion: Compared to non-diabetic and IDDM patients, NIDDM patients with AMI were at the highest risk for peri-operative complications after CABG in this setting. These patients also suffered from a decreased long-term survival.