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Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery

Michael E Halkos1, John D Puskas, Omar M Lattouf

  • 1Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.

The Journal of Thoracic and Cardiovascular Surgery
|September 23, 2008
PubMed

Insights

Adequate diabetic control, measured by hemoglobin A1c, is crucial for patients undergoing coronary artery bypass grafting. Poor glycemic control significantly increases the risk of adverse outcomes, including mortality and infections.

Area of Science:

  • Cardiology
  • Endocrinology
  • Surgical Outcomes

Background:

  • Diabetes mellitus is linked to worse outcomes after coronary artery bypass grafting (CABG).
  • Hemoglobin A1c (HbA1c) reflects long-term glycemic control.
  • The predictive value of HbA1c for adverse events post-CABG is not well-established.

Purpose of the Study:

  • To investigate if preoperative hemoglobin A1c levels predict adverse outcomes in patients undergoing CABG.
  • To assess the association between glycemic control and in-hospital complications.

Main Methods:

  • Retrospective analysis of 3089 patients undergoing elective CABG.
  • Preoperative HbA1c levels were prospectively recorded.
  • Multivariable logistic regression and ROC curve analysis evaluated HbA1c's association with mortality, renal failure, stroke, myocardial infarction, and wound infection.

Main Results:

  • Elevated HbA1c predicted in-hospital mortality (OR 1.40 per unit increase, P=.019).
  • HbA1c > 8.6% correlated with a 4-fold increase in mortality.
  • Increased HbA1c was associated with higher risks of myocardial infarction, deep sternal wound infection, renal failure, and cerebrovascular accident.

Conclusions:

  • Preoperative elevated hemoglobin A1c is a strong predictor of adverse events following CABG.
  • HbA1c testing can enhance risk stratification for CABG patients.
  • Optimizing glycemic control before CABG may improve patient outcomes.
Abstract

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