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Pre-operative glycaemic control and long-term survival in diabetic patients after coronary artery bypass grafting

Salil Deo1, Varun Sundaram2,3, Muhammad Adil Sheikh4

  • 1Surgical Services, Louis Stokes Cleveland VA Medical Center, VA Northeast Ohio Healthcare System, Cleveland, OH, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 10, 2021
PubMed

Insights

Elevated pre-operative glycated haemoglobin (HbA1c) levels above 8% in patients undergoing coronary artery bypass grafting (CABG) are linked to higher mortality and adverse cardiac events. Managing HbA1c is crucial for long-term outcomes after CABG surgery.

Area of Science:

  • Cardiology
  • Diabetology
  • Surgical Outcomes

Background:

  • Diabetes mellitus is a significant comorbidity in patients undergoing coronary artery bypass grafting (CABG).
  • Pre-operative glycemic control, measured by glycated haemoglobin (HbA1c), may impact long-term outcomes after CABG.

Purpose of the Study:

  • To evaluate the association between pre-operative glycated haemoglobin (HbA1c) levels and long-term outcomes in veterans undergoing isolated coronary artery bypass grafting (CABG).

Main Methods:

  • Analysis of Veteran Affairs data from 2006-2018 for patients with diabetes mellitus undergoing isolated CABG.
  • Patients were stratified into four groups based on pre-operative HbA1c levels (<6.5%, 6.5-8%, 8-10%, >10%).
  • Multivariable Cox proportional hazards models and competing risks models were used to assess mortality, myocardial infarction (MI), and repeat revascularization.

Main Results:

  • A total of 16,190 patients were analyzed, with a median follow-up of 5.8 years.
  • Mortality rates increased with HbA1c levels >8%, particularly above 9%.
  • Pre-operative HbA1c levels of 8-10% and >10% were associated with increased risk of MI (HR 1.24, 1.39) and reintervention (HR 1.20, 1.24) compared to HbA1c <8%.

Conclusions:

  • Pre-operative HbA1c levels exceeding 8% are associated with an increased risk of mortality and adverse cardiac events in patients undergoing CABG.
  • Optimizing glycemic control before CABG surgery may improve long-term patient outcomes.
Abstract

Keywords:
Adverse cardiovascular eventsCoronary artery bypass graftingDiabetes mellitusGlycosylated haemoglobinSurvival

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