In-hospital outcomes of coronary artery bypass grafting in patients taking sodium-glucose co-transporter 2 inhibitors

   Objective: to evaluate the effect of sodium-glucose co-transporter type 2 inhibitors (SGLT-2i) in patients with type 2 diabetes mellitus (T2DM) on survival and the course of the early postoperative period during myocardial revascularization using coronary artery bypass grafting (CABG).

   Materials and methods: an analysis of previous oral hypoglycemic therapy was performed in patients with type 2 DM who underwent CABG (from June 1, 2024 to December 31, 2024) at the Krasnodar Research Institute of Cardiology and Cardiology No. 1. During the analyzed period, myocardial revascularization by CABG was performed in 458 patients, of whom 119 suffered from T2DM. The latter were divided into groups depending on the previous oral hypoglycemic therapy: group 1 — patients who took at least 3 months before CABG and sodium-glucose co-transporter type 2 — 30 people; group 2 — patients who took other hypoglycemic therapy before CABG — 89 people.

   Results: group 1 was statistically significantly younger (mean age 62.83 ± 9.01 versus 67.40 ± 4.88, p = 0.018). Of the concomitant pathologies in group 1, low functional class of heart failure predominated (I and II according to NYHA: 66.67 % versus 53.33 %, p = 0.038). Laboratory data of group 1 were better in glomerular filtration rate (86.05 ± 15.16 ml/min versus 72.03 ± 15.97 ml/min, p < 0.001) and more favorable lipid profile (total cholesterol 3.59 ± 0.90 mmol/l versus 4.18 ± 1.11 mmol/l, p = 0.027). In group 1, clinically insignificant ketonuria (0.5-1.5 mmol/l) without metabolic acidosis was detected in 4 patients in the early postoperative period. In the early postoperative period, complications were less common in group 1 (46.67 % versus 73.33 % in group 2, p = 0.035), which, however, did not affect the length of hospital stay (10.80 ± 3.88 days in group 1 and 11.20 ± 4.60 in group 2, respectively, p = 0.717) and in-hospital mortality (mortality was 0 % in both groups).

   Conclusions: this study demonstrates a reduction in a number of early postoperative complications, probably due to anti-inflammatory and positive cardiorenometabolic effects, and a decrease in left ventricular volume overload on the background of iNGLT-2. It is noteworthy that not a single case of euglycemic ketoacidosis in the postoperative period has been reported, despite the fact that “major surgeries” such as CABG are considered to be at high risk of developing EKA against the background of the use of drugs of this group in patients with DM2. In addition, a more favorable lipid profile and glomerular filtration rate during iNGLT-2 therapy may have advantages in terms of long-term prognosis, which must be confirmed or refuted in large samples of patients with an assessment of long-term outcomes and postoperative outcomes.

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