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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.
Insights
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.
Background:
Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes after coronary artery bypass grafting (CABG), but the role of postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with major adverse events (MAEs) after isolated CABG.
Methods:
This retrospective study evaluated 2215 patients who underwent isolated CABG from January 2012 to March 2018 at 2 medical centers. Postoperative GV in the first 12 hours and 24 hours was measured by the SD, coefficient of variation, and mean amplitude of glycemic excursions. The primary outcome (MAEs) was the composite of postoperative cardiac arrest, pneumonia, renal failure, stroke, sepsis, reoperation, and 30-day mortality. Multivariate logistic regression assessed the independent association of GV with MAE.
Results:
A total of 2215 patients met the study criteria, and an MAE developed in 260 patients (11.7%). High 12-hour and 24-hour postoperative GV were associated with elevated HbA1c, insulin-dependent diabetes, renal failure, and nonelective operation. Multivariate logistic regression analysis showed MAEs were associated with increased mean postoperative glucose in the first 12 hours (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.008-1.018; P < .001), the first 24 hours (OR, 1.017; 95% CI, 1.010-1.024; P < .001), and 24-hour postoperative GV (OR, 1.22; 95% CI, 1.09-1.37; P < .001). MAEs were not associated with preoperative HbA1c or 12-hour postoperative GV.
Conclusions:
Increased 24-hour but not 12-hour postoperative GV after CABG is a predictor of poor outcomes. Preoperative HbA1c is not associated with MAEs after adjusting for postoperative mean glucose and GV.
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