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Published on: September 15, 2023
Preoperative Glycosylated Hemoglobin: A Risk Factor for Patients Undergoing Coronary Artery Bypass
Pradeep Narayan1, Sarang Naresh Kshirsagar2, Chandan Kumar Mandal2
1Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India.
Insights
High blood sugar (HbA1c ≥6.5%) in patients undergoing bypass surgery increases risks for respiratory issues and sternal wound infections, but not mortality. This finding is crucial for managing diabetic patients before cardiac procedures.
Area of Science:
- Cardiology
- Endocrinology
- Surgical Outcomes
Background:
- Rising prevalence of diabetes in patients with coronary artery disease.
- Importance of glycemic control in cardiovascular patients.
Purpose of the Study:
- To investigate the association between high Glycosylated hemoglobin (HbA1c) and adverse outcomes in patients undergoing elective coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective analysis of 4,678 patients undergoing elective CABG.
- Grouping patients based on HbA1c levels (<6.5% vs. ≥6.5%).
- Multivariable analysis to assess the impact of HbA1c on outcomes, including subgroup analyses for diabetic and nondiabetic patients.
Main Results:
- An HbA1c level of 6.5% or higher was independently associated with increased respiratory complications (OR, 1.05; P=.01) and sternal dehiscence (OR, 2.16; P=.04).
- No significant difference in mortality rates was observed between groups (OR, 1.36; P=.08).
- The association between elevated HbA1c and adverse outcomes was not observed in nondiabetic patients.
Conclusions:
- Preoperative elevated HbA1c (≥6.5%) is a significant risk factor for deep sternal wound infection and respiratory complications following CABG.
- Glycemic control is critical for improving surgical outcomes in patients with coronary artery disease.
Background:
The prevalence of diabetes in the population of patients presenting with coronary artery disease continues to rise. The aim of this study was to assess whether high Glycosylated hemoglobin (HbA1c) was associated with adverse outcomes in patients undergoing elective coronary artery bypass grafting.
Methods:
A retrospective observational study on prospectively collected data in 4,678 patients undergoing elective, isolated coronary artery bypass graft procedures in a single institution over a 4-year period was conducted. Patients were grouped into those with adequate preoperative control of hyperglycemia (HbA1c <6.5%) and those with suboptimal control (HbA1c ≥6.5%). Multivariable analysis using HbA1c as a binary independent variable was undertaken in the whole group. A subgroup analysis in diabetic patients and in nondiabetic patients was performed. The effect of HbA1c on outcomes at higher levels (HbA1c ≥8.0% and HbA1c ≥9.0%) was also assessed.
Results:
A total of 4,678 patients (mean age, 58.8; male, 4,254) were included in the study. HbA1c was less than 6.5% in 2,476 (52.93%) patients and 6.5% or higher in 2,202 (47.07%) patients. On multivariate analysis, there was no difference in mortality rates between the groups (odds ratio, 1.36; 95% confidence interval [CI], 0.95 to 1.953; p = 0.08). Overall, an HbA1c of 6.5% or higher was an independent risk factor for respiratory complications (odds ratio, 1.05; 95% CI, 1.008 to 4.631; p = 0.01) and sternal dehiscence (odds ratio, 2.161; 95% CI, 1.008 to 4.63; p = 0.04). An association between HbA1c levels and adverse outcomes was not seen in nondiabetic patients. No additional adverse postoperative complications were seen with increasing HbA1c levels (HbA1c ≥8.0% and HbA1c ≥9.0%).
Conclusions:
An HbA1c level of 6.5% or higher in patients presenting for coronary artery bypass grafting was associated with a significant increase in the incidence of deep sternal wound infection and respiratory complications.
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