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Increased Glucose Variability Is Associated With Major Adverse Events After Coronary Artery Bypass
Kathleen C Clement1, Alejandro Suarez-Pierre1, Krisztian Sebestyen2
1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
The Annals of Thoracic Surgery
|August 11, 2019
Summary
Increased 24-hour postoperative glucose variability after coronary artery bypass grafting predicts poor outcomes. This finding highlights the importance of monitoring glucose levels post-surgery for better patient results.
Area of Science:
- Cardiology
- Endocrinology
- Critical Care Medicine
Background:
- Elevated preoperative hemoglobin A1c (HbA1c) is linked to adverse outcomes in coronary artery bypass grafting (CABG).
- The impact of short-term postoperative glucose variability (GV) on major adverse events (MAEs) following CABG remains unclear.
Purpose of the Study:
- To investigate the association between short-term postoperative glucose variability and major adverse events (MAEs) after isolated coronary artery bypass grafting (CABG).
- To determine if preoperative hemoglobin A1c (HbA1c) predicts MAEs independently of postoperative glucose metrics.
Main Methods:
- A retrospective analysis of 2215 patients undergoing isolated CABG between January 2012 and March 2018.
- Postoperative glucose variability (GV) was assessed within the first 12 and 24 hours using standard deviation, coefficient of variation, and mean amplitude of glycemic excursions.
- Multivariate logistic regression was employed to evaluate the independent association of GV with the composite outcome of MAEs (cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, 30-day mortality).
Main Results:
- Major adverse events (MAEs) occurred in 11.7% of patients (260/2215).
- Increased 12-hour and 24-hour postoperative GV correlated with higher HbA1c, insulin-dependent diabetes, renal failure, and nonelective operations.
- Multivariate analysis revealed that increased mean postoperative glucose in the first 12 and 24 hours, and 24-hour GV, were significantly associated with MAEs (ORs ranging from 1.013 to 1.22).
- Neither preoperative HbA1c nor 12-hour GV showed a significant association with MAEs after adjustment.
Conclusions:
- Elevated 24-hour postoperative glucose variability is an independent predictor of adverse outcomes following CABG.
- Postoperative glucose management, particularly within the first 24 hours, is crucial for improving patient outcomes after CABG.
- Preoperative HbA1c levels do not independently predict MAEs when postoperative glucose metrics are considered.
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