Diabetic patients produce an increase in coronary sinus endothelin 1 after coronary artery bypass grafting.

Diabetes is associated with altered vascular responses, and diabetic patients demonstrate increased morbidity and mortality after coronary artery bypass grafting (CABG). We tested whether endothelin (ET)-1 levels in this patient population differed from those in nondiabetic subjects after CABG. Of 14 consecutive patients who underwent CABG by the same surgeon, 7 had type 2 diabetes and 7 were nondiabetic. The two groups did not differ significantly in preoperative ejection fraction, number of vessels bypassed, cross-clamp time, or Parsonnet's score. Coronary sinus blood samples were obtained before cardioplegic arrest and then obtained at 1 and 15 min after each of two reperfusion periods: reperfusion A (native coronary perfusion plus the left internal mammary artery), reperfusion B (saphenous vein graft perfusion). ET-1 was significantly increased at all reperfusion time points in diabetic patients compared with nondiabetic patients. In diabetic patients, reperfusion after CABG can trigger the release of ET-1, which may be a contributing factor in the increased cardiac morbidity seen in this patient population.